Bill To:


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

Services Rendered To:


Paul Hurt
893 Bob Johnson Road
China Spring, TX 76633
Policy # 99039050642

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-RN-424-22-1578 04/14/2022 04/28/2022 On Receipt Speegleville V.F.D.

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

    $300.00
    1
    $300.00
  2. 102 Engine Response (Per Hour)

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

    Command 1

    $150.00
    1
    $150.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    Command 2

    $150.00
    1
    $150.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Highway 6 and FM 185 - Waco, Texas

Subtotal $1,376.00
Total Due $1,376.00


Updated
April 28, 2022 @ 3:16 pm

Invoice updated by Geoffrey.

Status Update
April 28, 2022 @ 3:16 pm

Status changed: Draft to Pending.

Updated
April 28, 2022 @ 3:31 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 6:33 am

Invoice viewed by 64.124.8.25 for the first time.

Viewed
November 2, 2023 @ 10:20 pm

Invoice viewed by 24.45.123.216 for the first time.