STATEMENT DATE 03.05.2025
CUSTOMER NO. 1994940
CA LICENSE NO: GC#810553
BILL TO: JOB SITE:
CC:
Job Number Estimator Claim No. Payment Terms Purchase/Work Order
117802887 Paul Leal Kesterson 002.061873.00.S Net 30 Days Invoice Date Invoice # Amount Payment Balance
10/29/2024 2066464 $118,929.19 $118,929.19
10/29/2024 222611 ($812.83) $118,116.36
$118,116.36
4713 GREENLEAF COURT, UNIT C
MODESTO, CA 95356
PHONE: (209) 236-1100
INVOICE/STATEMENT
Insurance Company
Prism Assurance Ltd
FAX: (209) 236.1133
TAX ID NO: 84-1309171
MERCED CA 95340
EMAIL CONTACT: [email protected]
Per our agreement, Administration Fees of 1.5% per month, plus interest at 10% per annum shall accrue as of the 31st day after the invoice date.
In the event the customer defaults on the payment pursuant to the credit terms and the account is turned over for collection, the customer is also responsible to pay all collection costs and any legal fees incurred in the collection of all past due monies. ALSO, WE RESERVE THE RIGHT TO FILE A LIEN ON THE PROPERTY.
TERMS: DUE UPON RECEIPT - PAYMENT IS LATE AFTER 10 DAYS Reminder: Please include the invoice number on your check.
CITY OF MERCED
3033 G STREET
Description
TOTAL NOW DUE
CITY OF MERCED
678 WEST 18TH STREET
MERCED CA 95340
Emergency Service Fire Mitigation
Agreed Upon Audit Adjustment
Payment is due upon receipt.
Any inquires regarding this invoice should be submitted to us within 10 days from the date of this invoice.
Please note contractual interest applies, accrues and is payable in addition to this balance due on this invoice.
Please include the invoice number on your check,
make all checks payable to BELFOR USA Group, Inc. and remit to:
4713 Greenleaf Court, Unit C
Modesto, CA 95356
THANK YOU FOR CHOOSING BELFOR!
www.BELFORUSA.com
Attachment 2
Any inquiries regarding this invoice should be submitted to us within 10 days of the receipt of this invoice.
Please note contractual interest applies, accrues and is payable in addition to this balance due on this invoice.
Please include the invoice number on your check,
make all checks payable to BELFOR USA Group, Inc. and remit to:
4713 Greenleaf Court, Unit C
Modesto CA 95356
THANK YOU FOR CHOOSING BELFOR!
www.BELFOR.com
INVOICE
4713 GREENLEAF COURT, UNIT C
MODESTO CA 95356
PHONE: (209) 236-1100
FAX: (209) 236-1133
EMAIL: [email protected]
TAX ID NO: 84-1309171
CA LICENSE NO:
GC# 810553
INVOICE NO. 2066464
INVOICE DATE 10/29/2024
CUSTOMER NO. 1994940
BILL TO: JOB SITE:
CITY OF MERCED
678 WEST 18TH STREET
MERCED CA 95340
CITY OF MERCED - 3033 G ST
3033 G ST
MERCED CA 95340
JOB NUMBER ESTIMATOR CLAIM NO. INSURANCE CO. PAYMENT TERMS PURCHASE/WORK ORDER
117802887 Paul Leal Kesterson Prism Assurance Ltd Net 30 Days
DESCRIPTION AMOUNT
DOL: 08.27.2024
Emergency Service Mitigation:
Due to Fire Loss $118,929.19
Non-Taxable Amount $118,929.19
Taxable Amount $0.00
Sales Tax - 0%
TOTAL DUE THIS INVOICE USD $118,929.19
002.061873.00.S
Food and beverage costs as described in Internal Revenue Code Section 274(e)(3) may be included on this invoice. Food and beverage costs incurred in connection with the completion of our agreed upon services are subject to the tax deduction limitations prescribed by Internal Revenue Code Section 274(n).
Any inquiries regarding this invoice should be submitted to us within 10 days of the receipt of this invoice.
Please note contractual interest applies, accrues and is payable in addition to this balance due on this invoice.
Please include the invoice number on your check,
make all checks payable to BELFOR USA Group, Inc. and remit to:
4713 Greenleaf Court, Unit C
Modesto CA 95356
THANK YOU FOR CHOOSING BELFOR!
www.BELFOR.com
CREDIT MEMO
4713 GREENLEAF COURT, UNIT C
MODESTO CA 95356
PHONE: (209) 236-1100
FAX: (209) 236-1133
EMAIL: [email protected]
TAX ID NO: 84-1309171
CA LICENSE NO: GC# 810553
INVOICE NO. 222611
INVOICE DATE 10/29/2024
CUSTOMER NO. 1994940
BILL TO: JOB SITE:
CITY OF MERCED - 3033 G ST
678 WEST 18TH STREET
MERCED CA 95340
CITY OF MERCED - 3033 G ST
3033 G ST
MERCED CA 95340
JOB NUMBER ESTIMATOR CLAIM NO. INSURANCE CO. PAYMENT TERMS PURCHASE/WORK ORDER
117802887 Paul Leal Kesterson 002.061873.00.S Prism Assurance Ltd Net 30 Days 002.061873.00.S
DESCRIPTION AMOUNT
Agreed Upon Audit Adjustment
Invoice No. 2066464 ($812.83)
Non-Taxable Amount ($812.83)
Taxable Amount $0.00
Sales Tax - 0%
USD ($812.83)