Bill To:

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

Services Rendered To:

Andrew Kerley
1850 Chapman Rd
GoodWater, AL 35072
POLICY# 5713429-B07-01


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00

  2. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00

  3. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00

  4. 317 Rescue Struts (# Used)

    $50.00
    2
    $100.00

  5. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  6. 326 Safety Fest (# Used)

    $2.50
    7
    $17.50

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 72757 Hwy 9- Ashland, AL

Subtotal $1,516.50
Total Due $1,516.50


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
May 15, 2023 @ 11:25 am

Invoice updated by Geoffrey.

Status Update
May 15, 2023 @ 11:25 am

Status changed: Draft to Pending.