Bill To:

Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:

Kenneth Schiwart
200 West Cedar
Wilburton, OK 74578
Policy # 191828923


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Indian Nation Turnpike @ MM 96 - Hanna, OK

    Ordinance Info: SALEM-RYAL FIRE DEPT. RESOLUTION NO. 72821

Subtotal $573.00
Total Due $573.00


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 26, 2021 @ 8:10 pm

Invoice updated by Geoffrey.

Status Update
August 26, 2021 @ 8:10 pm

Status changed: Draft to Pending.