Bill To:

STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:

Sally Thompson McCommon
17088 Faircrest Dr
Whitney, TX 76692
POLICY# 157 4084-F10-43J 001


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50

  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    20
    $40.00

  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 22 & Hcr 2421 E- Hillsboro, TX

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,040.00
Total Due $1,040.00


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
March 28, 2023 @ 3:01 pm

Invoice updated by Geoffrey.