Bill To:


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

Services Rendered To:


Judith Castillo
14908 FM 1762
Raymondville, TX 78580
POLICY# AU3-576991-003

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SP-612-24-64 05/05/2024 05/08/2024 On Receipt Nueces County ESD #3

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

    $500.00
    2
    $1,000.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  3. 103 Rescue Response (Per Hour)

    $400.00
    2
    $800.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    2
    $400.00
  5. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  7. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    2
    $150.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00
  10. 324 Traffic Cone (# Used)

    $5.00
    12
    $60.00
  11. 326 Safety Fest (# Used)

    $2.50
    10
    $25.00
  12. 302 Hand Light (# Used)

    $5.00
    10
    $50.00
  13. 336 E-Flare (Per Use, # Used)

    $5.00
    5
    $25.00
  14. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 70 & CR 63 A- Bishop, TX

Subtotal $4,040.00
Total Due $4,040.00


Updated
May 8, 2024 @ 10:10 pm

Invoice updated by Geoffrey.

Status Update
May 8, 2024 @ 10:10 pm

Status changed: Draft to Pending.