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BACKWATER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this form o. 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 allowing <br />city staff to identify how costs eligible for the Backwater Prevention Device Rebate 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 />Addition:✓t costs may be added to bottom of the form. <br />5'EGtT'�i <br />Business NameAalp(• a—lo Sri Q+- in�e License Number: <br />Busiress Mailing Address: <br />Slate <br />Phone:( -.Dctn �X?t: ,l Email:0i82(a(-✓nm-rrCV ,CN:r2'r, c'.5n <br />Category <br />Description <br />Units <br />Duanti <br />Rate <br />Total <br />Administration <br />Administration I management <br />Hours <br />Labor <br />CCTV Inspection <br />Hours <br />_i—_— <br />5�-- <br />BVVV Install <br />Hours <br />Pipe replacement <br />Hours <br />Surface restoration <br />Hours <br />Site cleanup <br />Hours <br />Materials <br />Downspouts 1 drainage imp. <br />Backwater valve <br />flours <br />Per Unil <br />Grinder pump <br />Per Unit <br />Side sewer pipe (up to 8 feet) <br />Feet <br />rr rr <br />Imported Backfill <br />Yards <br />Rentals <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 Unil <br />Hour <br />a <br />3� <br />2 <br />Fees <br />Disposal fees by item <br />Yards <br />Delivery fees if not covered by labor <br />Eligible Total <br />Other Costs <br />Costs not associated with BVVD, and <br />not eligible for rebate (detaii below) <br />1 <br />r i <br />Ineligible Total <br />Total <br />DZS <br />Revised 910312014 <br />