Bill To:

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

Services Rendered To:

Billie Trojanowski
2009 Mazda
VIN. # JM1CR293990328980
Policy # 432244012653A001


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00

  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  4. 331 Air Bags (# Used)

    $150.00
    2
    $300.00

  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  6. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00

  7. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  8. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00

  9. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00

  10. 317 Rescue Struts (# Used)

    $50.00
    1
    $50.00

  11. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  12. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $2,275.00
Total Due $2,275.00


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
December 8, 2021 @ 6:49 pm

Invoice updated by Geoffrey.

Status Update
December 8, 2021 @ 6:49 pm

Status changed: Draft to Pending.