Bill To:

COUNTRY INSURANCE
1100 W Evergreen Ave
Effingham, IL 62401

Services Rendered To:

Policy# P010327271
Owner: Noah Adams
Driver: Gerald Gordon
HIghway 43
Russellville, AL 35654


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    2.25
    $787.50

  2. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00

  3. 331 Air Bags (# Used)

    $150.00
    6
    $900.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    2.25
    $225.00

  6. 404 Scene Lighting (Per Hour)

    $75.00
    2.25
    $168.75

  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 43, Tuscumbia, AL

    Ordinance Info: Littleville Volunteer Fire Dept. Resolution

Subtotal $3,231.25
Total Due $3,231.25


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 17, 2023 @ 2:37 pm

Invoice updated by Karen Smith.

Status Update
January 17, 2023 @ 2:37 pm

Status changed: Draft to Pending.