Bill To:


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

Services Rendered To:


Isabella Briones
2725 Blue Ridge Dr
Mesquite, TX 75150
POLICY# 00175626

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-29432-A 11/17/2023 01/09/2024 On Receipt Angus Vol. Fire Department

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

    $400.00
    1.25
    $500.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 219 NB IH 45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Viewed
July 22, 2024 @ 5:17 am

Invoice viewed by 69.171.249.3 for the first time.