Bill To:

USAA CASUALTY INSURANCE
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:

Clifton Barnes
2104 N.W. 54th Street
Lawton, OK 73505
Policy # 015021379


Product
Price
Qty
Amount

  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  2. 102 Engine Response (Per Hour)

    $350.00
    1.75
    $612.50

  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  4. 102 Engine Response (Per Hour)

    $350.00
    1.75
    $612.50

  5. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  8. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  10. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

    11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-44 @ MM 46 - Lawton, OK

Subtotal $2,737.50
Total Due $2,737.50


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
July 12, 2021 @ 8:10 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2021 @ 8:10 pm

Status changed: Draft to Pending.