1628 COLBY AVE 2022-04-13 - Laserfiche WebLink

� . BACKWATER PREVENTION PROGRAM INVOICE COST BRE�4KDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater Prevention Device rebate program. Either this form or your own invoice form with the following line items can be submitted. This allows you to invoice your client according to your existing biiling lemplate while allowing city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. Only labor and materials directly related to the installation and funetion af a backwater prevenfion device are eligible for City reba[e and there%re should be included on the upper half of ihis form. Additiona!costs may be added to 6oftom of the form. ` �� (' ��,(.(i /�y Business Name:.��;��ILY_P�5�nse Number. I'� �j�`TJ Business Mailing Address: o��tX� LCcr�clit �11�- �(fL'� ccJA 9k��3 City State Zip Phone:��/O •'��'� Email: � �]m� �can,4�7L��S;r1��C;��F°l;CcS�] � Cata o Descri tion Unfts Quanti Rate Total Administration Administr2tion/management Hours Labor CCTV Inspecfion Hours BWV instali Hours Pipe replacement Hours Surface restoration Hours Site cleanup Hours Downspouts/drainage imp. Hours Materials Backwater vaive Per Unit } Grinder pump Per Unit Side sewer pipe(up to 8 feet) Feet " Imported Bac�ll Yards Surface Restoration Materials Lump to soil, rass seed,concrete, etc. sum Cover(irrigation box or load b�ering Per Unit I cover a Rentals S ecify equipment Hour Fees -Disposal fees by item � Yards Delivery fees if not covered hy la6or EII ible Total ' ` $ oiher Costs Cosis not associatetl with BWD, and not eli ihle for rebate detail below ' � n Ineligible Total � •n n V $ II Total $ ✓�ti O� I 1Z-�-,`` I Revised 9/03/2014 I