Bill To:

FARM BUREAU INSURANCE
5400 UNIVERSITY AVENUE
WEST DES MOINES, IA 50266-5997

Services Rendered To:

Dustin Walker
342 Hayes Street
Lebanon, MO 65536
POLICY # APR0618972


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1.75
    $612.50

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  3. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    1
    $50.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 304 SCBA Cylinder (# Used)

    $25.00
    3
    $75.00

  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    3
    $75.00

  7. 309 Power Tool (# Used)

    $50.00
    1
    $50.00

  8. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

    9. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 30691 North Highway 5 - Lebanon, MO

Subtotal $1,420.00
Total Due $1,420.00
Total Payments Received $1,420.00
Balance $0.00


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
September 23, 2022 @ 2:42 pm

Invoice updated by Geoffrey.

Status Update
September 23, 2022 @ 2:42 pm

Status changed: Draft to Pending.

Updated
September 23, 2022 @ 2:45 pm

Invoice updated by Geoffrey.

Status Update
December 29, 2022 @ 1:09 pm

Status changed: Pending to Paid.

Payment
December 29, 2022 @ 6:09 pm

Admin Payment
Payment Total: $1,420.00