Bill To:

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

Services Rendered To:

Daniel Dominguez
1309 WedgeWood Ave
Odessa, TX 79761
POLICY# 467 4411-J23-43B 002


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00

  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  3. 211 Salvage Cover (Amt Used)           

    $35.00
    1
    $35.00

  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00

  5. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

    6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 224 SB IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,210.00
Total Due $1,210.00


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
February 6, 2023 @ 1:22 pm

Invoice updated by Geoffrey.

Status Update
February 6, 2023 @ 1:22 pm

Status changed: Draft to Pending.