Bill To:

STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:

Donald Lane
500 Meadowbrook Circle
Amory, MS 38821
Policy # C084456C1924G


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    3
    $1,500.00

  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    3
    $1,500.00

  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    3
    $1,500.00

  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

    6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 MM 254 West of Checotah, OK

Subtotal $4,850.00
Total Due $4,850.00


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
February 8, 2021 @ 11:49 am

Invoice updated by Geoffrey.

Status Update
February 8, 2021 @ 11:49 am

Status changed: Draft to Pending.