Bill To:


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

Services Rendered To:


Blake Steptoe
(Owner-Driver)
(Home State Co. Mutual)
Policy #99039048513

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-309-22-009 01/20/2022 01/25/2022 On Receipt Zavalla Fire Department

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

    $300.00
    2
    $600.00
  2. 102 Engine Response (Per Hour)

    $350.00
    2
    $700.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

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

    $50.00
    1
    $50.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2109 @ FM 3124 - Zavalla, Texas

Subtotal $1,812.00
Total Due $1,812.00


Updated
January 24, 2022 @ 4:23 pm

Invoice updated by Geoffrey.

Status Update
January 24, 2022 @ 4:23 pm

Status changed: Draft to Pending.