Laserfiche WebLink
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 />Preve�tion Device rebate program. Either this form or your own invoice form with the following line items can <br />be submilted. This allows you to invoice your clienl according to your existing billing template while allowing <br />city staff to identify how costs eligible tor 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 e(iyible for City rebate and therefore should be incfuded on the upper half of this form. <br />Additional costs may be added to bottom of the torrn. (� Z� /'�c �i6 V� l�l <br />c���"� �l /�y <br />, �, ,�(e License Number: �j����"rJ <br />Business Name;�4rYl� Pr; �� i� �r11�.--�'`�— <br />- . . _ � �-- - <br />Business Mailing Address: <br />' • - r 1 �._ u .J b� I � _ . " )/ <br />Revised 9/03/2014 <br />