Bill To:


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

Services Rendered To:


Alejandro Francisco
1820 Martin Luther Ave Apt A
Arlington, TX 75110
POLICY# SNH488242

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C24-6601 03/25/2024 04/23/2024 On Receipt Angus VFD

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

    $400.00
    1
    $400.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 226 S/B IH45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,150.00
Total Due $1,150.00


Updated
April 23, 2024 @ 12:23 pm

Invoice updated by Geoffrey.

Status Update
April 23, 2024 @ 12:23 pm

Status changed: Draft to Pending.