834 GRAND AVE 2022-04-15 - Laserfiche WebLink

BACKWATER PREVENTION PROGRAM d INVOICE COST BREAKDOWN Please use this Invoic� Cost Breakdovm as a tempiate for invoices submitted as part of the Backv�ater Prevention Device rebate program. E�Iher this form or your osvn invoicr, form w.ith ihe following line items can be submitted. This allov+s you to invoice your clienl according to your existing billing femplate �vhiie allowing ciry slafi to idenbfy how cosls el�aible for the Bar.'r.water Prevention Device Rebate �ti�ere accrued. Only labor and materials directly rclated to the installation and (unetion of a b er half o(�his formn device are efigible (or City rebate and lhere(ore should 6e included on the upp Addifional costs rnay Ue added to bottom o( the form. 5.:`u : L�,C. , � L V Bus�ness IJame %�;']'1,�� i"1 5C'_�?�i.�`�'-5�-��= License Numbec _ _ !�?SJ,�1U _ ___ _.—_—. Business fvlailing Address: _��%;_ LEc1.��L_ i /�.�:---1— "� � --��fl- ---0 `-�%��'=3 — City State Zip �hone'�-Y�'�iv_��Y2Si-� -----EmaiC��tGillk�'irczn�;�i�_L:ll�l.S..dc�.c:s::C__�s>7J'1 ------ --- -- -- — - -- — � DCS[n lion �._.._ r.,..__�:... T o.,�„ I TOt31 � Ca��_L---.�_ - I Adminislration LAdmini;Uatan � management Labor CCTV Inspeclion ____ __ � _ __ BV:N Instail �_ � Pipe replacement __ _ j j Surfacc resloral��on _ _ C- � Sde cieanup __ _ pocrospouts / dramage imp. tdatcrials —? Backvralervaive_ —_--_ r 1� Grinder pump f'---- -I SiAe seu�er oioe lun l0 8 feeU ' Imported �ack511 i— Surface Restora!ion Matenals �top Soil•grass s<ed, concrete, etc.) _ rCovcr (irrigation box or laad bearing � _ � coyer�— --- --- i Rentals Specify equipmenl �� _ _ _ ' -- - — -�1`��-1.`—��i-- �- — --- -- ---- - — - — -- - Fces Dlsposal fces by ilem __ ___ i -- -__- - - - -- - - nelwery_fces rf nnt crncrcd by Iabor_ � Elic iblc Total — - -- Othcr Costs Gosls not assaciated ti:�ilh BVVD, and not eligible lor rebate (detail below) _ � --- — - - �) - -- �— — -- - --`.'�L -�U�t Ccln hr�cr ii -T qy � --- ____'� � J�l )� __ _'.__ 7otal Revised 9/03/2014 Hours Hours _ ` _ � Hours �,_ _ Hours • ,� I _ _ Hours 1 Hours _ �_ Hours � Per Unit I"/:R1SIl,i3�r I C. � � �, �� G�- Yards Lump sum Per Ui — --r-- � �C� - - �� -- -� .�. %,� , -- ,— —_ - _ I � -_ '— __-_ ----=_r=_ G �� — — -- — — � � — � - ----� - . SoZ�'J • _;