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BACKWATER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Please ube 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 allowir.g <br />city staff to identify how costs eligible for the Backwater Prevention Device Reb;ie 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 mey be added to bottom of the form. <br />Business Name:,License Number: _����`►� <br />Business Mailing Address: <br />State <br />Phone:5;� Email_�fr%_crr�mHrircz�]GLeSadPr'�r�r C't <br />'�i� - <br />Category <br />Administration <br />Labor <br />Description <br />Administration I management <br />CCTV Inspection <br />Units <br />Hours <br />Quanti <br />Rate <br />Total <br />BWV Install <br />Hours <br />Pipe replacement <br />Rows <br />Surface restoration <br />Hours <br />Site cleanup <br />Hours <br />Downspouts I drainage imp. <br />Hours <br />Materials <br />Backwater valve <br />Grinder pump <br />Per Unit <br />Per Unit <br />_ <br />Side sewer pl a up to 8 feel) <br />Feet <br />" I <br />Imported Backfill <br />Yards — <br />1 <br />— <br />�� <br />_ <br />a <br />ai7 <br />_ <br />Rentals <br />--- <br />Surface Restoration Materials <br />(top soil grass Seed, concrete, etc) <br />Cover (irrigation box or load bearing <br />cover) <br />Specify equipment — <br />Lump <br />SUM <br />Per Unit <br />Hour <br />Fees <br />Disposal roes by item <br />Yards <br />_.Y- <br />_ _ <br />Delivery fees if not covered by labor <br />Eligible Total <br />a <br />Other Costs <br />Costs not associated with BWD, and <br />not eligible for rebate (detail below <br />^— <br />M$ <br />Ineligible Total <br />Total <br />— .___. <br />$e <br />V Mn' r rvv <br />Rovisod 910312014 <br />