Bill To:

State Farm Insurance
One State Farm Plaza
Bloomington, IL 61710

Services Rendered To:

Cobalt Kiser - Driver
Brad Kiser - Owner
11252 Upper State Line Road
Vivian, LA 71082
Policy # 4328580A0743


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    2
    $700.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2
    $300.00

  3. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00

  5. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00

  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 8, Cass County Texas

Subtotal $1,795.00
Total Due $1,795.00

Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
November 6, 2019 @ 2:22 pm

Invoice updated by Karen Smith.

Status Update
November 6, 2019 @ 2:22 pm

Status changed: Draft to Pending.

Updated
November 6, 2019 @ 2:25 pm

Invoice updated by Karen Smith.