Bill To:


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

Services Rendered To:


Rickey Murray
12881 FM 1428
Midway, Texas 75852
Policy # TTXL-20078-000

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XR-403-2021-52 04/14/2021 04/24/2021 On Receipt Electra Fire Department

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

    $350.00
    1
    $350.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  4. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  5. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 1739 and US 287 South Bound - Electra, Texas

    Ordinance Info: City of Electra Resolution NO. 2018-05

Subtotal $1,260.00
Total Due $1,260.00


Updated
April 23, 2021 @ 6:20 pm

Invoice updated by Geoffrey.

Status Update
April 23, 2021 @ 6:20 pm

Status changed: Draft to Pending.

Updated
April 23, 2021 @ 6:21 pm

Invoice updated by Geoffrey.

Updated
April 23, 2021 @ 6:22 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 11:45 pm

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