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BACKWATER PREVENTiON PRO(�RAN! <br /> d INVOICE GOST BR�AKDOWN <br /> Please use tfiis IrivoiCe Cosi Dreakdotvn as a template for invoices submitled as part of the B�ckwater <br /> Prevention Device rebate program. Either this form or your own invoice form�vith tiie following line items can <br /> be submitted. This allows you to invoice your clienl according to your existing billing template while allo�ving <br /> city sfaft lo identi(y how costs eligible for the Backt�ater Prevention Device Rebate were accrued. <br /> Only/abor and rnaferlals dlrectly related to the installation and functinn of a backwater prevention . <br /> device are eligiUle for Ciry iebate and therefore should be included on the upper half of this form. <br /> Additional costs may 6�a d��o��7torn of the form. <br /> A�� �� b.s�s 8 1 ' s <br /> Business Name: n.� �.ew1.�- License Number; ' <br /> Business Mailing Address:�c�� �G��1�S�- �-�(����� W�" "l��°ZG <br /> I � City State Zip <br /> Phone:��-��6�ylq3 Email:�v5o�u�'��e�tM�4�.r•k'-1CC�C4/,-ti�j <br /> Cate o Descri tion Units �uantit f'ate Total <br /> Administralioo Adminislration I monagement Hours <br /> Labor CCTV Inspeclion Hours <br /> BWV Install Hours p <br /> Pipe replacement Hours �. Q <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> Dovmspouts I drainage imp. Hours <br /> Materials Backwater valve Per UNt �; . oD.00 �00 <br /> Grinder{5ump Per Unit <br /> Side sev,�er pipe(up to 8 feet) Feet <br /> Imported Back(ill Yards <br /> Surfac�Restoration Materials lump <br /> to soii, rass seed, concrele,etc.) sum <br /> Cover irrigalion bo r load bearing Per Unit ( a�,o� � <br /> cover_ <br /> Rentals Speci(y equipment Hour <br /> Fees Disposal fees by ilem Yards , D,p0 '�.0.� <br /> Delivery fees iF nol covered by fahor __ s : a;�00�oD <br /> — ; y� <br /> Eli IbleTotal n � � ���� O <br /> Other Costs Coslc not associated vrilh RWD,and <br /> nol eli ible for rebale dP�ail below <br /> ro F..� 3 ii� <br /> � <br /> i 1u�»�a <br /> -- ---• � e7l <br /> Ineligible Total 5 <br /> Total — S <br /> Revised 9/03/201� <br />