Bill To:

FOREMOST INSURANCE
PO BOX 2450
GRAND RAPIDS, MI 49501-2450

Services Rendered To:

Vehicle Owner
Policy # 0078546435


Product
Price
Qty
Amount

  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  7. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 11600 FM 730 North - Azle, Texas

Subtotal $1,008.00
Total Due $1,008.00


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 12, 2021 @ 5:13 pm

Invoice updated by Geoffrey.