Bill To:

Old Republic Insurance
307 N. Michigan Avenue
Chicago, IL 60601

Services Rendered To:

Forestry South Logging
2090 Obrie
Zwolle, LA 71486
POLICY # CAP3716337


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  3. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

    4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 63 & Highway 147 - Zavalla, Texas

Subtotal $500.00
Total Due $500.00


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
June 2, 2022 @ 2:31 pm

Invoice updated by Geoffrey.

Status Update
June 2, 2022 @ 2:31 pm

Status changed: Draft to Pending.

Updated
November 5, 2022 @ 5:06 pm

Invoice updated by Geoffrey.