Bill To:

ALFA INSURANCE
207 Hwy 78 W
Jasper, AL 35501

Services Rendered To:

TCW Construction
1100 County Rd 73
Randolph, AL 36792
POLICY# A2260471


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient

    Stephen Kiley
    1054 County Rd 33
    Calera, AL 35040

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 900 Block AL Hwy 155- Jemison, AL

Subtotal $1,500.00
Total Due $1,500.00


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
January 27, 2023 @ 11:25 am

Invoice updated by Geoffrey.