Bill To:

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

Services Rendered To:

Jerry Meeks
917 E. Beth Street #B
Whitney, Texas 76692
POLICY # PA3265209


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00

  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  6. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00

  7. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00

  8. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00

  9. 201 Oil Absorbent Material (# Used)

    $35.00
    4
    $140.00

  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  13. 330 Backboard (# Used)

    $25.00
    1
    $25.00

    14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3053 SH 22 - Hillsboro, Texas

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,774.00
Total Due $1,774.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
September 23, 2022 @ 3:36 pm

Invoice updated by Geoffrey.