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BACKWATER PREV�NTION PROGf2AM <br />INVOICE COST 13REAKDOWN <br />Piease use this invoice Cost E3reakdown as a tempiate for invoices submitted as part oi the Backwater <br />Pre��ention Device rebate program. Either this form or your own invoicr. form with the foliowing line items can <br />be submitted. Tliis allows you to invoice your client according to your existiny billing tzmplate while allo�ving <br />city statf to idenlify hc.v costs eligible for the Backwater Prever,tion Device Rebate vdere acorued <br />Only labor and materials directly related to the insfallation and function of a backwater prevenrion <br />device are eligible for City rebate and there(ore should be included on the upper Italf of tfiis form. <br />Addifioral costs ntay be added lo botfom o/ the (nrm. J� G� <br />5�.�u., � L ��' <br />Business Name:��'1_4 ' �.�?�--:�L�� License Numbec __�>�J;j,� �Y _ _ _ <br />f3usiness Mailing Address: ����c LGt (_�� '_f �___�=��.�1���'�, —G��-- �L� ? � <br />City State Zip <br />Phone:,.�'�Q�a�'iS.'y� Err�il:�'„j�i.C^ r � . �i1c_[.}G]lG.S;rle-�c-rr ('. C'c>�.')� <br />Administretion <br />Labor <br />Materials <br />Rentais____ <br />Fecs <br />gtinn/ Install <br />Pipe replacement __ <br />Surface restoralion <br />Site cleanup <br />prnvnspouts I drainage imp. <br />�ackwater valve <br />Grinder pump <br />gfde se�ver pipe (up to 8 feel! _ <br />Imported 8ackfill _ <br />Surface Restoralion Materials <br />1�o soa, rass seed, concrete, etc. <br />_P_—�------ <br />Cov�r �irngalion box or load bParing <br />coverj---- - . --- -- <br />Specify equipment _ __ _ <br />_yra..u� T�s—L—(ve---- <br />(�isposol t�es by item --.—_ <br />t)edvery fees if nol mvered by_labor <br />Eli iblc Total ' �' .�- <br />Othcr Costs �osls not associated wdh BVVD, and <br />not eliaible lor rebate Sdetail below) <br />-- ---- -- - - ---- -V � <br />_-- --__ — =-��Z <br />Total <br />Revised Q�0?�2014 <br />Hours <br />Hours <br />Hours <br />Hours <br />Hours <br />Per Unit i' <br />Per Unit <br />Feet '� <br />Yards <br />Lump <br />sum J <br />Per Unil <br />Hour <br />===_1--=�_--�{;��J��-�- - <br />G �,��- <br />� /►�/�s <br />