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i <br /> BACKWATER PREVENTIAKDOWNRAM ' <br /> INVOICE COST BRE � <br /> Piease use this Invo�ce Cos� Breakdown as a template for mvoices submitled as p3rt o�the Back�vater <br /> Preven'ion Device rebate program. Either this forrn or your own invoice form �vith the following line iterrs ca�� <br /> be subm lted. This allows you to invoice your client according to your existing billing lemplate v�hi,e allo�ving <br /> city slail to �dent�fy how costs eGgible for Ihe Back�vater Prevention Device Rebate were a.:crued. <br /> Only labor and rnaterials directly rElated to the Installation and function of a ba(�+�f o�his formn <br /> device are eligible (or Ciry rebate�nd therefore should be included on the upp. <br /> Additional costs may be added to bottom o/the (ortn. L� I <br /> 5'rr.12'�',• ��� "• - - <br /> ,QµNr'� 'i� '-�iL� -S�� License Number. _[-SS��----- -- <br /> Business Name: _ �' ' <br /> /� C� _I=.�'L�.%�-�.L�__��?�-�-- <br /> Lcc - ` �—_iLL " scacc 7i� <br /> Business M�.i6ng Address� c��c.__ f� City <br /> � Email.(�ifk�1/, r�1M�'i'Lr�r:�,�}i�ClL1c1-_`�:��:t�'!-• ('S`?�1 <br /> Phone:,�(�'�(_v-��! -- ____ � <br /> -------- — Units T�uanlii� Rate _ Total_ _� <br /> - - - ' <br /> --"- - ' Descri tion - <br /> Cato o . __ _.�- ---�- - Hours t <br /> Administration Admin�strat�on ! management____ Fi�" �� _ _- 3�� - �� --� <br /> ---- - <br /> Labar __ GG7V Inspection _ -- - Hours <br /> --- -- -I <br /> gWV lnstall - - <br /> ---- - - <br /> - --- � Houts ' <br /> �_ _ - — -- <br /> -- — <br /> Pipe replacement Hour � �� ��� <br /> Sur�ace rosloration ___.__ �- �- <br /> � — -- -'— Hours __ � <br /> - _ - _- Si_�e cle.anup — Hour, -- --- - - � <br /> pown`Pouts I drainage imP _ -- ��1> -' <br /> .— _ .. Per Unil . �{�c�ll� .� - _!a��—�_ <br /> Materiais_ _ . Backwater valve_ __.-- per Unit - - <br /> __- .__. <br /> Grinder pump - - - — <br /> _ � <br /> F-"---- SidesewerP�DeNPtoBfeet) __ Feet •�� -�' J =r��� - -=-�7 -- <br /> ----_ -'' Yards , -- -_ <br /> ---- - -- <br /> - --- <br /> Imported Bac i - i --- <br /> - - - - <br /> _ ---_- <br /> ---- Lum I <br /> f- gur�aceRestoradonMatenals �,,,��� __"7��) <br /> (to�soil,grass seed�concrete_etc.�_ sum _,_�___. _ _,.. = — - <br /> L ---- Cover(irriga!ion box or load beanng Per Unil I + 1� �a - <br /> cove� - --- - _ Hour - --i -- - <br /> Rentals Specifyequipmenl _ _ , __ - _ --- L - - _ <br /> ' � i �) i . <br /> — — _-�c�l�__����— -- — - -1 — - _ <br /> -- - -- -- <br /> � ."�_ __ _ " .� -i� <br /> -- - ..._--- --- Yardx _ �`�a��-. <br /> � Feos -- - pisposnl frc;by dem __ - - -- . -- - -__ ---- .- _- <br /> --- <br /> --'_ ..- -- -- - -� - <br /> ---- - - �- -- _. ._ - --- -- - -- <br /> - -- - - <br /> prhve tees if nui covr.mA hy labor _ _ _. ._ . __. <br /> ry - <br /> � _ _ '" � • �� .� � , <br /> � Eli ible ToWI -:--- - =C '�- <br /> Co5 s nol assucialed�vtlh E3WD, and <br /> � Other Cosis - -�� � <br /> rnot elic�le lor reUate(delail br.low __ __ — <br /> ---- <br /> — - - _.._ <br /> -- - _ <br /> ___ - �_� � �� . -� h ����31 <br /> ____ __ _ __ ___ _ _ _ _ __ -- <br /> - __ _-_-_- __ __, ___��<< �..____ <br /> �•w�..1c <br /> � ---- -- — — — - g ��r ,u7rf' <br /> ' Ineligihle Total <br /> $_•�J.3L ' ' <br /> - ' -- - - <br /> Total_--- - <br /> Revised 9/03i201-0 <br />