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BACKWATER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Piease use this Invoice Cost f3reakdown as a template (or invoices submitted as part of the Backwater <br />Prevention Device rebale program. Either Ihis form or your own invoice (orrn wilh lhe following line items can <br />be submitted. This allows you to invoice your clienl according to your exishng billing ternplate white allowing <br />city staH to identify how costs eligible for the �ackwater Prevention Device Rebale were accrued. <br />Only labor and materials directfy related to fhe installation and /unction of a backwater prevention <br />device are eligible lor City rebate and lherefore should be incfuded on the upper hal/ ol this /orm. <br />Adddional costs may bc added fo boflorn o/ thc torm. <br />Biisiness Name ��'Y?�_ �( ,„v,n� �,� License Number �c.�'rupF� E:G, ,; v � __ <br />�usiness Mailing Address: �-� ���� �P l .S'��i-�c:m�Sr1 c.��1 ._�S"e_%i <br />Ci,y State Zio <br />Phone: J�.---� l`,(. - 6`,''2`! [maiC_=1�t._+ i1 ��{f��(p}�r„� , r�.� <br />� Categ� Oescrlptlon _ Units Ouantil R tc Total , <br />�, Adminislrati� AdminisValion � management __ Hours �_ _ � � J <br />Labor CCN Inspection Hours <br />-- - - --- BNN Insta�l i Hours <br />_ Pipe tep�acement _ _ Hours <br />Surface <br />Downspouts I drainage imp. <br />Matcrials Backwatervalve __ __ _ <br />- - - Gnnderpump <br />Sidc sewcr pipc (up to 8 fecl) <br />I impnrled �ackfill <br />+ Surlace Restoralion Materiais <br />____ top so;l, yrass seed, concrete, el� <br />Cover (irrigation box or load 6earing <br />covcr) <br />Rentals Specdy cqmpnwnt <br />Fces �_D�sposal fces by item __ _ <br />_ i _— <br />-- --i-- -- - - ---- <br />_ Delivery Ier.s d nol coveied by la�or <br />Olhcr Cosls �o.ts IIUI'JSSOCIBIC(I Willl E3WD. ilil� <br />__ not eliyible lor rel�ate (datad below <br />----- - - _ _- - ------ ---- <br />-1----- --- _ <br />iible Total <br />Revised 9/03/2014 <br />Hours <br />Hours � <br />Hours <br />Per Unit 1 � .H '-� �_ <br />Per Unit <br />Peet <br />Yards <br />Lump -- - -- <br />sum <br />Per tlnil <br />Hour -- - <br />Yards <br />- - - /.��a,� _ � �Z . _. <br />L <br />,�: . '7'Z <br />H <br />