Bill To:

GERMANIA INSURANCE COMPANY
507 Hwy. 290 E
Brenham, TX 77833

Services Rendered To:

Peter Loos
P.O. Box 520
Chireno, Texas 75937
Policy # 43043357462


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 147 @ Lakeview Grocery - Zavalla, Texas

Subtotal $658.00
Total Due $658.00


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
July 27, 2021 @ 2:47 pm

Invoice updated by Geoffrey.

Status Update
July 27, 2021 @ 2:47 pm

Status changed: Draft to Pending.