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BACKWATER PREVENTION PROGRAM <br />� ='T lNVOICE COST BREHKDOWN <br />Please use this In �oice Cost Breakdown as a template for invoices submitteci as part of the Backwater <br />Preven?ion De��ice rabate progrem. Either this form or your ovrn inveice form with the foilowing line items can <br />be suhmiN.ed. This ailows you +.o involce your client according to your existing billing template while allowin� <br />�i;y siaf( to identiiy hotv cosls eligible for the E3ack�sater Preventio�i Device Rebate uvere accrued. <br />Only labor and materials directly 2lated to the installation and function of a backwater preventiun <br />devlCe are eligibla for City rebate and therefore shou!;; be included on the upper half of this form. <br />Additicnal costs may qe added o Gotiom of tfie form. <br />Abs�I�4e. s�-o�rr^ ` C <br />Business Name: r,�wc ' e.w�s License Number. l� o SS �� J <br />�usiness Niailing Address: � 7�3 _�J��� _ • w• �-'^����`S �� ���a�' <br />Phone: O� -�GS- "i ��� _ Email: �Tb o k �j'T�IY'M c� Xry`iP �`�-r �(�?n ut .0 <br />�- --r— ... n..t�� i n„�..an. Rata Total <br />A�ministra[ion P,dministratlon <br />Labor CCN Inspec9 <br />A7ateriais <br />Surface resioration <br />Site cleanup <br />Downspouts 1 drainagc <br />Backvrater valve <br />Grinder pump <br />Side sewer pipe (uo to <br />Importeci Bac�ll <br />Suriac� RestoraGon �4 <br />Cover irrigation box oPtaac <br />_— cover) -_- <br />f Specify equipment <br />_ _T — `�:bL�.'� , <br />Disposal fees by i(em <br />velivery fees if not covered <br />Total <br />Othcr Costs <br />Ineligibia Total <br />Tatal <br />Costs nol associated with [3WD, <br />not eligiblo for rebate (detail belc <br />P,evised 9/03/2014 <br />Hours <br />Hours <br />Per Unit <br />Per Uiiii <br />Feet <br />Yards <br />Lump <br />Hour <br />Yards <br />�O.cO <br />%D.GO <br />F �� <br />$ <br />$ <br />SO. Gt� <br />� <br />