Laserfiche WebLink
BACKWA`fER PREVENTION PROGRAM <br />d INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breakdotvn as a tempiate for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this form or your ovm invoice form e+ith the foliov�.�ing line items can <br />be submilted. This allo�vs you to invoice your client ��ccording to ycur existing billing template while allovaing <br />city staff to identdy how costs eligible for ihe Backc�ater Prevention Device Reb�te �vere accrued. <br />Only labor and materials directly relafed to the installation and function of a backwater pievention <br />device are eligible for City rebate and therefore should be incfuded on the upper half of thls form. <br />Additional costs may bc added to boffom of the form. � <br />5:'�l� i � � V <br />Business Name:�'L1��1r�,;'��.4�.��L �icense Nwnher: _[) ���i�_.•,�_ ___ <br />f3usiness �viailing Address: �.����c LC[ �'l 1�_._�(%� r•��� ��%���-3 <br />City State Zip <br />Phone:_a�-�a':���aZ2Si-� Email:� �;i ��C�rc��� � � �'ciP1S�� <br />i aamir <br />I Labor <br />� Materials <br />f-- --- -- <br />'-- — — <br />; Rentals <br />r-- ---- <br />i_ _---- <br />Fees _ _ _ _ <br />tEliaible Total <br />Othcr Costs <br />Ineligible Total <br />Total _ _ _ <br />Revised 9/03/2014 <br />�dministration / managemenl <br />CCTV Inspeclion <br />gWV ;nsiall <br />Pipe replacemenl <br />Surface restoration <br />Sile cleanuo � <br />poe:nspouls / drainage imp. <br />Backw;der valvr. <br />Grinder pump <br />Side see�er pipe (up to 8 feet) __ <br />Imported BackGll <br />Surtace Restoration A4aterials <br />Q� soil, grass seed, concrele, etc�__ <br />Cover (irrir�alion box or load bearing <br />�ov���_--_-- <br />Specify equipment __ __ <br />�y�j„yv. TrctG 1�' __ <br />Disporal fee�: hy ilem -_ _ _- -- <br />Dr.livcry fecs d not covrrcd �y labor <br />Cosls nol associaled �+�ilh BVVD, and <br />not e�ible for rebate detail belowL <br />i.7 <br />Per Unit <br />Per Unit <br />feet <br />Yards <br />Lump <br />sum <br />I-Z-Zv15 <br />a <br />