Bill To:

Southern County Mutual Insurance Co.
PO Box 809076
Dallas, TX 75380-9076

Services Rendered To:

Charles Dorsey
14244 County Road 46
Tyler, Texas 75704
Policy # 55DTX608147


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  2. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00

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

    $100.00
    1
    $100.00

  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4303 Highway 64 - Ben Wheeler, Texas

Subtotal $506.00
Total Due $506.00


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 25, 2021 @ 4:15 pm

Invoice updated by Geoffrey.

Status Update
February 25, 2021 @ 4:15 pm

Status changed: Draft to Pending.