Bill To:

Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:

Owner: Vertis Jordan
Driver: Detrick Jordan
Policy # 65649829511


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. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. 409 Manpower (Per Hour)

    $50.00
    3
    $150.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 220 Interstate 45 Southbound - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $1,050.00
Total Due $1,050.00


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, 2021 @ 4:57 pm

Invoice updated by Geoffrey.

Status Update
June 2, 2021 @ 4:57 pm

Status changed: Draft to Pending.