2707 GRAND AVE 2022-04-18 - Laserfiche WebLink

BACKWATER PREVENTION PROGRAM INVOICE COST BREAKDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as pait 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 billing template 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 function of a backwater prevention device are eligible for City rebate and therefore should be included on the upper half of this form. Additional costs may be added to bottom of the fonn. Business Name: Pri lrzin Se0C 4,!5 r'2 License Number: Business Mailing Address: Cate o Administration Description Administration / management Units Hours Quanti Rate Total Labor CCTV Inspection Hours f BWV Install Hours Pipe replacement Hours Surface restoration Hours Site cleanup Hours Downspouts I drainage imp. Hours Materials Backwater valve Per Unit Grinder pump Per Unit Side sewer pi e (up to 8 feet) Feet rr57 Imported Backfill Yards Surface Restoration Materials _qgg soil grass seed concrete etc. Cover (irrigation box or load bearing cover) Lump sum Per Unit D -of Rentals Specify equipment Hour Fees Dis oral fees by item Yards Delivery fees if not covered by labor Eli Ible Total 5 Other Costs Costs not associated with BWD, and not eligible for rebate (detail below) U� — — QV Ineligible Total $ Total _ _ $ k/kA/15 Revised 910312014