Bill To:


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

Services Rendered To:


Stephen Robinson
LISCENSE PLATE# BW82803
VIN# 1FTSW21547EB34665
POLICY# TTXL-67676

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-RN-424-23-1775 01/26/2023 02/02/2023 On Receipt Speegleville VFD

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

    $300.00
    1.25
    $375.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7700 N HWY 6- Waco, TX

Subtotal $1,280.75
Total Due $1,280.75


Updated
February 2, 2023 @ 12:29 pm

Invoice updated by Geoffrey.

Status Update
February 2, 2023 @ 12:29 pm

Status changed: Draft to Pending.