Bill To:

Middlesex Assurance Company
213 Court St P.O. Box 891
Middletown, CT 06457

Services Rendered To:

Gary Ingram
1767 Griffin Shoals Rd
Dadeville, AL 36853
POLICY# A0177820001


Product
Price
Qty
Amount

  1. 316 Cribbing – Lvl 3 (Class A Truck) (Used)

    $500.00
    1
    $500.00

  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  3. 318 Ladder (# Used)

    $35.00
    1
    $35.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00

  5. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00

  6. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00

  7. 419 Environmental Spill

    $250.00
    1
    $250.00

  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00

  9. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  10. 317 Rescue Struts (# Used)

    $50.00
    2
    $100.00

  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. 103 Rescue Response (Per Hour)

    $400.00
    3
    $1,200.00

    13. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 70644 Hwy 9- Goodwater, AL

Subtotal $3,067.00
Total Due $3,067.00


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
August 25, 2023 @ 12:07 pm

Invoice updated by Geoffrey.