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Backwater Prevention Device <br /> Rebate Program <br /> Invoice Cost Breakdown 'i <br /> Please use ihis Invnice Cost Breakdown as a template (or invoices submitted as part of lhe Backwater <br /> Prevenlion Device rebale pro�ram. Either Ihis lorm o•your own invoice form w�th thc fol!owing Ime items can <br /> be submitted. <br /> Only fabor and materials directly related to the installafion and lunction ol a backwater preventlon <br /> device are eligible/or City re6ate and therefore should be lncluded on the upper hall ol this lorm. <br /> Addifronal cosfs may hc addcd lo hoffom o(Nie /orm. <br /> Company Narnc:_51_���_��Y��=_�C7 r_-_-( /J[ . Oate � �1 S , ��� <br /> ProperiyAddress ��.�c�0 �'��QSTn��T S;rLe'1' p�;o!'e � l,��l _ <br /> ------- -- <br /> - ---- - - - <br /> Category Oeseription Units puantity Rata Total <br /> -- - ----... ----------- -- ------ <br /> �Administration Adminislretion I m�nagement Hours ___ <br /> F--- - - - --- - <br /> ' Labor __�___._ _ -_ <br /> fCCTV Inspection __ _ Hours <br /> � - - -- �NNlnslatl - Hours_ I(p �]_� /S7Qcu <br /> pipe replacemenl_ Hours _ <br /> Surlace restoratmn Hours <br /> Sde cleanup Hours <br /> --- - - pawnspouts I dra�nage imp. Hours ---- -- - - _-- <br /> Malerials - _ - - -- - - <br /> Backwatr.r valvc P�r Unit o1/S`- a�U_ <br /> - - -- - Grmder pump - ---- Per Unit - <br /> --- ---- — <br /> __ -__ -- -- <br /> -- - Side sewer pipe_(up to 81eet)_--- Feel -- - __-__-_ � <br /> Imported Uackfill Yards <br /> guriar.e Resloration Materials Lump -- — � p , o <br /> lo sod,grass seed, r,onaete,elc. sum � I 7� -- � -__.J <br /> Covcr(irrigatio� box or load beaiing Pcr Uni� � <br /> cover)_ <br /> __ _ ._ __ � <br /> -- - - -- <br /> Rentals Sper.dy eqwpmr.nt <br /> --- - -- -- -- <br /> I'1 C'�'� HOuf �'� �� <br /> — - --- � hc?_�- _ 1 _ �Qc1— -- - -1_00 ___' <br /> Fces Di pn al Ices by dem -- Yards- -- 3 _L---- �-� <br /> - - �--- ��J .� <br /> Dehvery fees il nol covered by labor __ . <br /> Otl�er -- — _ . ____ _ <br /> -- �- ---- ---- . . .- <br /> Eligible Total S ��a� <br /> Olhcr Costs �osl:no�associated ivith BWD, and <br /> nol eligible for rebale_�Aetail_below) <br /> - - ---- - ------ <br /> Ineligible Total $ <br /> _ _.--------- Sublolal ---- $.�UO_ , <br /> _ - -- - <br /> - --- --- _ <br /> --- ---- - Taz�9.2%) - $ �Y`{-= <br /> ---- _ _ _= - --- <br /> - . _ Total $ '_l�Y� <br /> Revised 12/11/2014 <br />