Bill To:

ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:

Yakhalra Moody
1821 NW 92nd Street
Lawton, OK 73505
Claim # N8RD87OK


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00

  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00

  3. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

    4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 MM 254.5 West Bound - Checotah, OK

Subtotal $1,100.00
Total Due $1,100.00


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
January 20, 2021 @ 6:55 pm

Invoice updated by Geoffrey.

Status Update
January 20, 2021 @ 6:55 pm

Status changed: Draft to Pending.

Updated
January 20, 2021 @ 6:58 pm

Invoice updated by Geoffrey.

Updated
January 20, 2021 @ 7:01 pm

Invoice updated by Geoffrey.

Updated
January 20, 2021 @ 7:04 pm

Invoice updated by Geoffrey.