Bill To:


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

Services Rendered To:


Aguirre Arnulfo
411 E Lilly
Arlington, TX 76010
POLICY# X42S-40036075-0000

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-471816-A 11/09/2022 12/05/2022 On Receipt Callisburg VFD

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

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  5. 301 Hand Tool (# Used)

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

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 324 Traffic Cone (# Used)

    $5.00
    10
    $50.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: E Hwy 82 @ County Rd 163- Gainesville, TX

Subtotal $1,165.00
Total Due $1,165.00


Updated
December 5, 2022 @ 2:16 pm

Invoice updated by Geoffrey.

Status Update
December 5, 2022 @ 2:16 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 10:14 pm

Invoice viewed by 66.249.72.6 for the first time.