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BACKWATER PREVENTION PROGRAM <br /> INVOICE COST BREAKDOWhI <br /> Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater <br /> Prevention Device rebate program. Either this form or your own invoice form with the following line items can <br /> be submitted. 'fhis allows you to invoice your client according lo your existing billing template while aliowing <br /> city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br /> Only la6or and materials directly related to the instal/ation and function of a backwater prevention <br /> devlce are eligible for City rebate and there/ore should 6e included on the upper half of this form. <br /> Additional costs may be added to bofiom of the form. <br /> 8usiness Name: Pr�CCpY1,��`}-�� �i����icense Number. f�D`�i4 <br /> Business Mail?no Address: _n1(�(p �Q(`�i w �,_�UpI�P� ( L) q�_d.o_l_� <br /> City S ate iZ p <br /> Phone:o�CXo '��"�Ogo1 EmaiL• (�i(Y���G�n NY1Fr'�I�oK]�(�c�n-I Sidp Gsu[�. �QYrJ <br /> Cate o Descri tion Units QuanH Rate Total <br /> Administration Administralion I management Hours <br /> Labor CCN Inspection Hours � - , p — <br /> BWV Install Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Matarials Backwaler valve Per Unit pp ' <br /> Grinder pump Per Unil <br /> Side sewer pipe(up to 8 feet) Feet p <br /> Imported Bac�ll Yards � <br /> Surface Restoration Malerials Lump <br /> to soil rass seed concrete, etc. sum � C7 <br /> Cover(inigation box or load bearing Per Unit I � <br /> cover <br /> Rentals Specify equipment Hour <br /> � Fees Disposal tees by item Ya�ds <br /> De�ivery fees if not covered by labor <br /> 0. 4� � O •�ooZ <br /> Eli IbleTotal � �- <br /> Other Costs Costs not associated with BWD,and <br /> not eli ible for rebate delail below <br /> Ineligibie Total � S <br /> • Total _ � �• � <br /> Revised 9/03/2014 <br />