Laserfiche WebLink
BACKWA�ER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Please use this i�voice Cost Breakdown as a template for invoices submitted as pa�t of the Back� rater <br />Prevention Device rebale program. Either this form or your own invoice form tivith the followirn7 line items can <br />be submilted. This allows you to invoice your clienl according to your existing billing template t��hile allov+ing <br />city staft to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only labor and materials direcNy related to the installation and function of a backwater prevenfion <br />device are ellgi6le (or City rebate and therefore should be included on the upper half of this form. <br />Additional costs may bo added to bottom of the fomi. <br />rJ�'[tI'�� (�C' /' <br />Business Name;����<.�-;; irle License Number: (JrJ��`7� <br />Business Mailing Address: <br />Phone:c�Ya'�1� �;�1'���1 Emaii:i�a �)r��r��an�S��ii��n�f S;r1p�Nc� t�l: Cc�y <br />Revised 9/03/2014 <br />