Bill To:


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

Services Rendered To:


Dennis Martin
5851 Texas Hwy 77 West
Atlanta, Texas 75551
Policy # 2010279419


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

    $350.00
    1.45
    $507.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.45
    $435.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.45
    $217.50
  4. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 409 Manpower (Per Hour)

    4 x 2.5 hours 

    $50.00
    10
    $500.00
  8. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.5
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 8 Near CR 2225 - Cass County, Texas

Subtotal $2,220.00
Total Due $2,220.00


Updated
September 5, 2021 @ 5:49 pm

Invoice updated by Geoffrey.

Status Update
September 5, 2021 @ 5:49 pm

Status changed: Draft to Pending.

Updated
September 5, 2021 @ 5:50 pm

Invoice updated by Geoffrey.