Bill To:

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

Services Rendered To:

Joshua Orsak
3199 Deer Valley Ln
Sealy, TX 77474
CLAIM# 4352W824L


Product
Price
Qty
Amount

  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.25
    $250.00

  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00

  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50

  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00

  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1458 Grotto- Sealy, TX

Subtotal $1,566.50
Total Due $1,566.50


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
July 18, 2023 @ 12:27 pm

Invoice updated by Geoffrey.

Status Update
July 18, 2023 @ 12:27 pm

Status changed: Draft to Pending.

Updated
August 25, 2023 @ 11:37 am

Invoice updated by Geoffrey.

Updated
August 25, 2023 @ 11:37 am

Invoice updated by Geoffrey.