Bill To:


Home State County Mutual Insurance
P.O. Box 8036
Waco, TX 76714-8036

Services Rendered To:


Clinton Owens
403 W Lamar St
Richland, TX 76681
POLICY# 29297


Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    4.75
    $1,425.00
  2. 104 Tanker Response (Per Hour)

    $300.00
    4.75
    $1,425.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    4
    $800.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    4.75
    $475.00
  7. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 221 NB IH-45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $4,202.00
Total Due $4,202.00


Updated
December 16, 2022 @ 1:43 pm

Invoice updated by Geoffrey.

Status Update
December 16, 2022 @ 1:43 pm

Status changed: Draft to Pending.

Updated
December 16, 2022 @ 1:46 pm

Invoice updated by Geoffrey.