Bill To:

ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:

David Gutierrez
361 Oak Hill Dr
Sarasota, FL 34232
POLICY# 981592538


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1.5
    $750.00

  2. 103 Rescue Response (Per Hour)

    $400.00
    1.5
    $600.00

  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  5. 216 Oxygen (# Used)

    $25.00
    1
    $25.00

  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12771 CR 42- Jemison, AL

Subtotal $1,683.00
Total Due $1,683.00


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
October 17, 2023 @ 3:04 pm

Invoice updated by Geoffrey.

Status Update
October 17, 2023 @ 3:04 pm

Status changed: Draft to Pending.