Bill To:

Assurance America Insurance
P.O. Box 725009
Atlanta, GA 31139-0009

Services Rendered To:

Marvin Carrasco
1312 Knox Street
Griffin, GA 30223
Policy # PGA1923466


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.75
    $875.00

  2. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00

  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.75
    $875.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 Westbound @ MM 247 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $3,300.00
Total Due $3,300.00


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
December 8, 2021 @ 4:51 pm

Invoice updated by Geoffrey.

Status Update
December 8, 2021 @ 4:51 pm

Status changed: Draft to Pending.