Bill To:

Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:

Levi O'Riaey
5102 FM 1806
Texas
Ph# 940-273-2652
Policy # 6673238225


Product
Price
Qty
Amount

  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00

  6. 326 Safety Fest (# Used)

    $2.50
    5
    $12.50

  7. 302 Hand Light (# Used)

    $5.00
    1
    $5.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 730 North & Portwood Road - Azle, Texas

Subtotal $777.50
Total Due $777.50


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 24, 2021 @ 2:23 pm

Invoice updated by Geoffrey.

Status Update
October 24, 2021 @ 2:23 pm

Status changed: Draft to Pending.