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BACI(WAT�R PREVENTIOfV PROGRAhII <br />INVOICE �OST �REAKD(3WN <br />Piease use this Invoice Cost Dreakdown 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 acc:ording to your existing billing template while allowing <br />city staff to identify how costs eligible for tiie Backwater P•evention Device Rebate were accrued. <br />flnly Iabcr and materials dirccNy related ta� fhe Installafion and function ot a backwater prevention <br />device are eligible far Cily rebate and t�:erefore should be fncluded on the upper half o/ this /arm. <br />Addifiona! costs may be added tn bottom o! the 1orm. <br />Business Name: ���%✓� ���'�'14�— License Number: ����:v� 2�'Ol%P� <br />Business Maiting Address: P(0 F�I ��15��-���-"'✓1.�; �'v�z-`r (�W� �J'L `�' <br />Cdy State Zip <br />Phone: `�2�= �/�`j—UjL j EmaiL �n^EDiY1f G. /—'�'' C��»�r}i ��CM� <br />� _._____ — ..____._....., ii.,�r� ounntitv Rate Total <br />Administration � Adminislration / <br />Fecs <br />'J+��,(-inti� <br />_V---_ — <br />Eiigi6lr. Total <br />Othcr Cosis <br />Ineligiblc Total <br />Total <br />BWJ Install <br />Surface resloration <br />Site cleanup <br />Dov+nspouls / drair <br />Backwater valve <br />Grinder pump <br />Side sewer pipe (u <br />Imoorted Beckfill <br />=�� <br />fees <br />to 8 <br />or <br />fees if not covered by labor <br />Costs not associated with BWD, and <br />not eligible for rebate (delail below <br />Rr.vised 9/03/2014 <br />Hours <br />Hours <br />Hours _�.a l <br />Hours �t <br />Hours 6 C <br />Hours <br />Hours � ,��G <br />Per Unil 2�. L <br />Per Unit <br />Feet � �- <br />Yards _ <br />! ump � �p�' <br />sum <br />PerUnit I �y <br />-- � 4aisat.�k'��T_'�.,. ...--- —,-...+r�.."�,4+rt�si:-,.. . ,: <br />� ,�, ..+q:, <br />..,..�.c. t� .. _..:.�.J,.:..t�.w.en ,.,.._.:.. .�,,.ta�x.n.,,.....,:_.�_ ._ � . .,�.�i.L�a�:i <br />5 <br />� <br />