Bill To:

STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:

Policy# 365 6176-K05-43A 001
Owner: Belinda Morrison
Driver: Brandon Morrison
2279 CR 127
Whitesboro, TX 76273


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1.75
    $612.50

  2. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00

  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00

  4. 404 Scene Lighting (Per Hour)

    $75.00
    1.75
    $131.25

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

    $100.00
    1.75
    $175.00

  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    8. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: FM 371, North of CR 134, Gainesville, TX 76240

Subtotal $1,408.75
Total Due $1,408.75


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
January 17, 2023 @ 2:07 pm

Invoice updated by Karen Smith.

Status Update
January 17, 2023 @ 2:07 pm

Status changed: Draft to Pending.