Bill To:

NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:

Mariano Rico
85 CR 960
Jemison, AL 35085
POLICY# 2013159821


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00

  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00

  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  4. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00

  6. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00

  7. 216 Oxygen (# Used)

    $25.00
    1
    $25.00

  8. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00

  9. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00

  10. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  11. 306 Hose Per 50′ (Amt Used)

    $25.00
    4
    $100.00

  12. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  13. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  14. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 28530 US Hwy 31- Jemison, AL

Subtotal $2,406.00
Total Due $2,406.00


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 16, 2023 @ 10:50 am

Invoice updated by Geoffrey.

Status Update
November 16, 2023 @ 10:50 am

Status changed: Draft to Pending.