Bill To:

Germania Select Insurance Company
PO Box 645
Brenham, TX 77834

Services Rendered To:

Ira and Larry James
Policy# 4 304 003334009


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00

  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  3. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  4. 216 Oxygen (# Used)

    $25.00
    1
    $25.00

  5. 409 Manpower (Per Hour)

    $20.00
    3
    $60.00

    6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH77W East of Park

Subtotal $760.00
Total Due $760.00

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
August 24, 2019 @ 8:11 pm

Invoice updated by Karen Smith.

Status Update
August 24, 2019 @ 8:11 pm

Status changed: Draft to Pending.