Bill To:

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

Services Rendered To:

Johny McLellan
4333 Edinburg Way
Del City, OK 73115
POLICY# 3623676701


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  4. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  5. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  6. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  8. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  9. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  10. 419 Environmental Spill

    $250.00
    1
    $250.00

  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 100600 Hwy 177- Meeker, OK

Subtotal $1,718.00
Total Due $1,718.00


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
May 8, 2023 @ 2:37 pm

Invoice updated by Geoffrey.

Status Update
May 8, 2023 @ 2:37 pm

Status changed: Draft to Pending.