Bill To:

State Farm Insurance
One State Farm Plaza
Bloomington, IL 61710

Services Rendered To:

Rigoberto A. Montalvo - Driver
Marlon Fernando Montalvo- Owner
112 Deer Grove Court
Springtown, Texas 76082
Policy # 330 7097-D18-43


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    Unit # A 49

    $300.00
    1
    $300.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    Unit # BC 49

    $150.00
    1
    $150.00

  3. 102 Engine Response (Per Hour)

    Unit # E 249

    $350.00
    1
    $350.00

  4. 105 Utility Vehicle Response (Per Hour)

    Unit # S 49

    $150.00
    1
    $150.00

  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. 409 Manpower (Per Hour)

    $20.00
    6
    $120.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4800 Block of SH 199 and 100 Block of McDaniel Street

Subtotal $1,320.00
Total Due $1,320.00

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
December 15, 2019 @ 2:37 pm

Invoice updated by Karen Smith.

Status Update
December 15, 2019 @ 2:37 pm

Status changed: Draft to Pending.

Updated
December 15, 2019 @ 2:40 pm

Invoice updated by Karen Smith.