Bill To:

Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:

Nikki Brown
Urbana, MO 65767
POLICY# 531932996


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50

  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  6. 309 Power Tool (# Used)

    $50.00
    1
    $50.00

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

    $100.00
    1.25
    $125.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Clark St & US HWY 65- Cross Timbers, MO

Subtotal $1,020.50
Total Due $1,020.50


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
October 17, 2022 @ 4:54 pm

Invoice updated by Geoffrey.

Status Update
October 17, 2022 @ 4:54 pm

Status changed: Draft to Pending.