Bill To:


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

Services Rendered To:


Brayan Vega
9019 Meena
Nevada, TX 75173
POLICY# TX0075272H

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-806-A 11/03/2023 11/06/2023 On Receipt Lavon V.F.D.

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.75
    $350.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: S FM 1138/ CR 590- Nevada, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,685.00
Total Due $1,685.00


Updated
November 6, 2023 @ 9:54 am

Invoice updated by Geoffrey.

Status Update
November 6, 2023 @ 9:54 am

Status changed: Draft to Pending.