Paid

Invoice

From:

515 E. Carefree Hwy.
Phoenix, AZ 85085-8839

insurance@pibinc.com

Invoice Number INV-0194
Invoice Date June 26, 2019
Total Due $0.00
To:
Fusion Reinforcing LLC

33509 N 24th Drive
Phoenix, AZ 85085

Hrs/Qty Service Rate/PriceAdjustSub Total
1 WORKERS COMP POLICY / WOS - ANNUAL PREMIUM $492.003.00%$506.76
Sub Total $506.76
Tax $0.00
Paid -$506.76
Total Due $0.00