Bill To:

USAA CASUALTY INSURANCE
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:

Greg Autumn
2013 S. Thomas
Francis, OK 74844
Policyholder: Dylan Gray
Policy # 024876800C7101
Claim # 024876800-002


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00

  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.25
    $625.00

  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 Eastbound @ MM 250 - Henryetta, OK

Subtotal $1,625.00
Total Due $1,625.00


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
July 12, 2021 @ 3:26 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2021 @ 3:26 pm

Status changed: Draft to Pending.

Updated
December 28, 2021 @ 6:24 pm

Invoice updated by Geoffrey.