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i <br /> � <br /> � BACKVNATER PREVENTION PROGRAM � <br /> IN`JOICE CUST BREAKDOYdN � <br /> i <br /> Please use this Invoice Cost Breakdown as a template for invoices submitted as part of lhe Backwater � <br /> Preven!ion Device rebate program. Either lhis form or your own invoice torm with the following line items can ; <br /> be submilted This allows you to invoice your client according to your existing billing templete while allowing <br /> city staH tu identify how c�sts eligible for the Backwater Prevention Device Rebato were accrued. � <br /> i <br /> Only labo; and maferials d/rectly related to fhe lnstallaflon and function o/a backwater prevenflon ! <br /> devlce are eligible for City re6ate and there%re should be fncluded on the upper half o/thfs form. � <br /> Additional r,osfs may ue added fo bottom o/fhe lorm. <br /> _ �,���5�•,��.�-t-�' t,��p ! <br /> Business Name:�.�cz1.��N��-'��« „� ���crnse Number:_���,,,��.i1 <br /> Business Mailing Address:�_�L4cr� l.L�l.�� ���A 9�`�.(�'�_ � <br /> City State ZiP � <br /> Email:(�alkz�inni ri�nn ���d�4!�?��%,Nr C� <br /> Phone::2,�'�Gft�•�'�'1�'�. — �-- � � <br /> Category �Duscrl tion Untis �uanti Rata Tota� i <br /> D j <br /> Administratian 4aministralion I management Hours _ <br /> La:�or CCN Inspeclion Hours Y7 � � <br /> BWV Install � Hours __ ; <br /> Pipe replacement Hours _ � �.�- i <br /> Surfece resloration Hours <br /> SAe cleanup _ Hours ___ � <br /> Downspouts I draina�e imp. Hours <br /> Matorials Backweter valve Per Unit T � _ i <br /> Grinder pump Per Unit 1 <br /> Feet �� �� c� � <br /> Side sewer pipe(up ro 8 fee� _ - � <br /> Imported Bac�ll Yards _ __._ _ I <br /> Surface Resloretion Materiels Lump � , <br /> to soll rass see�concrete,elc.l sum ____ i <br /> Cover ngation o or load boaring Per Unft <br /> cover�-- ---- —�` �.�-- � <br /> Rentals ! Specify e uiq pment Hour _ i <br /> -- i��-�- �.�n <br /> -- — I <br /> Fees Dis osal tees by ilem _____ Yerds .. ._ I 'I <br /> � <br /> Delivery fees il nnt coverod by labor - --_---—.-- .. � <br /> EII Ibte Total $ � <br /> oth�.cosrs Costs not associated with BWD,and I <br /> nol eli�ible lor rebate delail below _ _-- <br /> t <br /> Inellgible Total $ I <br /> Total __ - -- $ ' <br /> . <br /> � <br /> I <br /> Ra��sa.��io3izor4 I <br />