Bill To:

KENTUCKY FARM BUREAU MUTUAL
9201 BUNSEN PARKWAY
LOUISVILLE, KY 40220-3792

Services Rendered To:

Victoria Palmer
265 Gain Hills Road
Burkesville, KY 42717
Policy # 0020931167


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    2
    $700.00

  2. 103 Rescue Response (Per Hour)

    $300.00
    2
    $600.00

  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00

  6. 404 Scene Lighting (Per Hour)

    $75.00
    2
    $150.00

  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00

  8. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 13000 Block of Burkesville Road - Breeding, KY

Subtotal $2,213.00
Total Due $2,213.00


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
October 24, 2021 @ 1:01 pm

Invoice updated by Geoffrey.

Status Update
October 24, 2021 @ 1:01 pm

Status changed: Draft to Pending.