Bill To:


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

Services Rendered To:


Melvin Cooper
832 CR 2351
Marietta, TX 75566
POLICY # TX0010004 1-1


Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  3. 302 Hand Light (# Used)

    $5.00
    1
    $5.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Highway 77 West of FM 250 - Marietta, Texas

Subtotal $670.00
Total Due $670.00


Updated
September 26, 2022 @ 3:21 pm

Invoice updated by Geoffrey.

Status Update
September 26, 2022 @ 3:21 pm

Status changed: Draft to Pending.