Laserfiche WebLink
BACKWATER PREVENTION PROGRAM <br />4wjlr INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this form or your own invoice form with the following line items can <br />be submitted. This allows you to invoice your client according to your existing billing template while allowing <br />city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />only labor and materials directly related to the Installation and function of a backwater prevention <br />device are eligible for City rebate and therefore should be included on the upper half of this form. <br />Additional costs may be added to bottom of the form. <br />Business Name: 14(rr^-c7 License Number. H-fnFPi.;St..� Ni <br />Business Mailing Address: <br />State <br />Phone: �,6- ef-b(re— 0 2y Email' Tr,-.-, I l •r r% 0yNi+-r;c" 4 mM <br />Category _ <br />Administration <br />Description <br />Administration / management <br />Units <br />Hours <br />Quantity <br />Rate <br />Total <br />Labor <br />CCTV Inspection <br />Hours <br />BWV Install <br />Hours <br />c" ' <br />Io <br />1'10cr <br />Pipe replacement <br />Hours <br />Surface restoration <br />Hours <br />p <br />1iI , <br />!u a <br />Site cleanup <br />Hours <br />ti ,J <br />e0 <br />VeNe <br />Downspouts / drainage imp. <br />Hours <br />Materials <br />Backwater valve <br />Per Unit <br />j (^•" <br />r' L• . <br />Grinder pump <br />Per Unit <br />Side sewer pipe (up to 8 feet) <br />Feet <br />Imported Beckfill <br />Yards <br />7.. <br />Surface Restoration Materials <br />(top soil, grass seed, concrete, etc. <br />Lump <br />sum <br />Rentals <br />Cover (irrigation box or load bearing <br />cover <br />Specify a of ment <br />Per Unit <br />Hour <br />_ <br />Fees <br />Disposal fees by item <br />Yards <br />3U <br />Delivery fees if not covered by labor <br />EII able Total <br />S <br />Other Costs <br />Costs not associated with BWD, and <br />not ell ible for rebate detail below <br />Ineligible Total <br />S <br />Total <br />S Z77G,v� <br />Revised 9/03/2014 <br />