Laserfiche WebLink
GRA� I <br /> BACKWATER PREVENYION PRO I <br /> INVOiCE COST BREAKDOWN i <br /> Please use this Invoice Cost Breakdown ae e tema�ate for invoiaea submitted as paA of the Backwater , <br /> Prevention Device rebaie program. Eilher this form or your own (nvoice form with the►ollowing lino Items can <br /> be submitted.Thls albws you to invoice your cifent according to your existing billing iemplate while allowing + <br /> city staH to identify how costs eliglble for the Backwater Preventfon Device Rebate were accrued. i <br /> devlc'e are ellg(ble foraCJry rebate and thereforejshoulA 6e lnclufded on Nre uppe�1 0�hfs�pt�n <br /> Addltlonal costs may be added fo boBom o/fhe form. ` �� <br /> Busfness Name:,a::'�✓„;r�,_,.�.=�? �-�Ld`'S'�� "�se Number. _ ��3��� <br /> '�G%�� L.r�•-l;vi �a2. �r I�,rt'�f ul A 9 tZ�r�3 <br /> Business Mailing Address: � City State Z�p <br /> Phone:,j�v , �,r.n ..y1Q� Emafl:�'il'�-��1nM•'�rirtZn��hFiG�7Pha �'�P 'N^�"r: ' m'► � <br /> Cate o Desc tion Unt4 �uanli Rete Total <br /> Hours <br /> AdmiNstration Administratlon/mana �e�► Hours � ! "" <br /> Labor CCN Ins ecdon Hours — <br /> gyyV Instell _ � . <br /> p e re iacement Hours I <br /> Sur�ece resloration Hou�s <br /> Site cleanu HouB � <br /> Douvn outs I draina e Im . H�� ` i <br /> Beckwder velve� Per Untl - f <br /> MabriNs per Unit <br /> Grinder um , , r � <br /> Side sewer i u to B Ieet Feet ' �� - <br /> Im orted Beckfill Yards <br /> Surfeca Reatorellon Meterlals lump . <br /> to soil r ss ed concrele ntc. sum � <br /> Cover itngedon bo�r loed bearing Per Unit ` � i <br /> cover �'—'— ` <br /> Hour � <br /> Rentala S ecity equipmenl ` � <br /> ` .. <br /> I <br /> F�ea Dis oanl feea b item Yerds <br /> Dellve feea B not covered b laba � <br /> ,o s <br /> EII ibleTotaf <br /> Costs not assocletetl wfU�BWD,and i <br /> Other Coats not el! ible for rebate detall bebw <br /> S <br /> Insli Ible Tohl b <br /> Total <br /> Revlsed 8/03/2014 <br />