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i <br /> i <br /> BACKWATER PREVENTION PROGRAM <br /> �' INVOICE COST BREAKDOWN <br /> Flease use this Invoice Cost Breakdo�vn as a lemplate for invoices submdted as part oi the [3ackwaler <br /> Prevenl�on Device rebate program. [ittier ihis form or your ov;n invoice form vrith the follovring line ilems can <br /> be submdted. This allows you to invoice your client ar.cording to you�existing billing temp�ate while allowing <br /> dty staH to idenli(y ho�v costs eliyible for lhe Dack�•iater Prevention Device Rebate v+ere accrued <br /> Only labor and materials directly related!o the installation and funcfion ol a backwaterprevention � <br /> device are eligible for'City rebate and therefore shoWd be included on the upper hal/of ihis lorm. ! <br /> Additiona!cos;.c may he added to bnttom ollhe lorm. � <br /> n i <br /> Business Name. �-IL-`2G 1 �-�--n l3 � N(.� L�cense Number �c`leo �t�L�<o 3 iv i ___ � <br /> Business (vlailing Address _�_��_��nk S;� 7 _ Jtvp{�p�n,SN (.�� ���'Zi✓ � <br /> City Slale Zip <br /> Fhonc .�n��r= t�la-U��Zi�--- [mail ��'�.ct'C{,�lid�5' �1 _�(':FIg�> . Cc;,v, _ <br /> I Categ� 'i Description ' Units I �uantit Rate Total �� <br /> Administration I AtlminisVaUon /management i Hcu�s � _;___ <br /> Labor CCNlnspection I Iiours 1,o <br /> I � <br /> ,.zJrL� BWVlnstall ---�- � -- -- Hours (4��'�00 `" / 'UO. .o : , <br /> __ Pipe replacemenl Hours_ I _ _ j <br /> Surface resloiation Nours � <br /> , — �-J -------- ' <br /> ' Sitecleanup Hours _ �, J _ � <br /> �� Do�vnspouts/drainage imn. Hours ' <br /> � M11atcrials I 8ack�vater valvc ^ Pcr Uni( I 274, po i <br /> Grinder pump Per Ur,it � <br /> Side sewer pipe(up to R feet) Feel � ; <br /> Imported Backfdl � 1'ards �-�- ---_- ---- i— ----_- I, <br /> Surface P,estoralion(iotenals —i Lidnp <br /> � <br /> _(lop sod, grass seed, concre;e, etc.) sum <br /> Cover(�rrig,tion box or load bearing Per Unit � <br /> cover) — �- ---- - -- <br /> Rentals Specdy equipmenl Hour � <br /> --- -- --- ' <br /> - -- --_ ---— —----- <br /> � <br /> � - - - - — - - - <br /> i <br /> I Pc`es Disaosal fees by ilem _ Yards ! <br /> — - - ------ — — � <br /> I <br /> i , <br /> _ _ - - _. . _ , <br /> i � Dclivery fees if nol covcred by IaLor � - - <br /> — ---- -- --- — - - - - __ _- <br /> -- - - - - -- - -- <br /> I [liqiblc Total i � � O � <br /> � Costs iiot assocurted�vith D�VD, and I ' <br /> Other Cosls i���eli. ible for rebale(detai'helow __ <br /> �m�C«�,��r Ttsa_� cv��2r��zt3� C'�s7- ' i' ---- — - - — <br /> f _ i _ <br /> f--- -- -- -- <br /> — --- <br /> – -- — <br /> I Inelic�ible Total ---� --- � ------ -- - `� : <br /> Total - - -- - -- -I- - - - I----� -- 5 - ��-2' 07 <br /> Rcvisev J,'03i2U t a <br />