Bill To:

HUDSON INSURANCE
PO Box 6818
Scranton, PA 18505-6818

Services Rendered To:

Asphalt Transport Inc.
17311 Market Street
Channelview, TX 77530
Policy # HMU200095-05


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Rafael Segovia
    1706 Oak Manor Drive
    Huffman, TX 77336

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: MM 224.5 Northbound on IH 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


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
March 30, 2022 @ 5:40 pm

Invoice updated by Geoffrey.

Updated
January 26, 2023 @ 1:30 pm

Invoice updated by Karen Smith.

Updated
January 26, 2023 @ 1:30 pm

Invoice updated by Karen Smith.