Bill To:

NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:

Raul Bautista
616 30th St S
Bessemer, AL 35020
POLICY# 219174996


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00

  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00

  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00

  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

    6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 26600 US Hwy 31- Jemison, AL

Subtotal $1,187.00
Total Due $1,187.00


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 19, 2023 @ 10:11 am

Invoice updated by Geoffrey.

Status Update
October 19, 2023 @ 10:11 am

Status changed: Draft to Pending.