Laserfiche WebLink
BACk:WATER PRE�'E:f�TION PfiOGRAAIO � <br /> �NV41C� COST IBREAlCD�W�1 <br /> Please use ihis Invoice Cost Breakdown as a template tor invoice:s submitted as part of ttx:13ackwa+.er � <br /> Prevention Device rebate program. Gilher this form or your own irn:oice form with thz following line ilsms :an ; <br /> be submitted. This allows you to invoice your client according to yaur cxisling billing template while 2�Ilowin� � <br /> city staff to identify how eosts eligible for the Beckwater Prevention Dovice Robate tvere accrued. <br /> Or.(y laborand materials direcfly related fo the installafiort and function ofa Y..ackwater prevention <br /> device are ellgible fnr Cfry rebate and therefor�e shou(d he encluded on the up;�er half of ihis form. j <br /> Addi6onal cosfs may be edded ro bottom ol the form. <br /> Business Name:�.�����i�-`� � License Number:�/P�— ��u N-Y d%/V' l-� ; <br /> � <br /> Business AAailing Address:�(O �� ���Sf����� ��'�� ��T �} � <br /> Ciry State Zig <br /> Phone: �IZI � LI S �—C�(Z�'� Email: 0`Yl� �I�� �Jfl'i�tLLC �74� (�,�`ii�,CDY� : <br /> C o Descri tion Un'rts Quunti Rnte Totnl <br /> Administretion Administration/management Hours �___ _ <br /> Lsbor CCN Inspecfion Hours J�O U <br /> BWV Instail Hours / _ � <br /> Pipe replacement Hours ( �-`- <br /> Surtace restoraUon Hours _� Z7 <br /> Site cleanup Hours L_ �v <br /> Dowaspouts!drainage imp. Hours ; <br /> Meterials BacMsatervaNe Per Unit / 'L�� _ <br /> Grinder pump Per UnR _ _ _ � <br /> Side sewer pipe(up ro 8 feet) Feet � <br /> Impotted Bac�ll Yards 1 _ � �� _ <br /> Surface ResroraGon Materiais Lump % � -� �' <br /> to soil, rass seed concrete, elc. sum _ <br /> Cover(irtigation box or load bearing Per Unit l �� <br /> cover <br /> Renwle Specify equipmenf Hour __ ��. <br /> F Disposal fees by item Yards_ _ __ I <br /> �^i9.V" --- — � � _ : <br /> Dclivery fees i not�vered by labor _,. __ I <br /> - <br /> --- <br /> _ �i.. _ <br /> Eli iblc Totni ----- - - - ',V $ ` .� . <br /> Othcr Coets Costs not associated wilh BWD,and � c_. � ; <br /> not eli ible for rebale detail below _ _ _.f�� � - �- I I �-- - <br /> - -- i <br /> Incli iblc Total ---- - - � `_+- <br /> Totnl _ .._ - — - -- ---'�� - -$ _ . _ <br /> I <br /> Rr,vised 9/03/2014 <br />