Laserfiche WebLink
BACKWATER PREVENTION PROGRAM <br /> INVC�ICE COST BREAKDOWN <br /> Please use this Invoice Cost Breakdown as a templste (or invoices submitted as pari of the Backwa!er <br /> Preventlon Oevice rebate program. Either Ihis form or your own invoice form with the tollowing line items c2n <br /> be submitted. This allows you to invoice your client according to your existing billing templaie while allo�viny <br /> city staH to identify how costs eligible for the Backveater Prevention Device Rebate evere accr�ed. <br /> Only labor and materials directty related to the installation and function of a backwater prevention <br /> device are elfgibfe for Ciry rebate and therefore should be included on the upper half of this fo►m. <br /> Additional costs may 6e added ro boftom of fhe lo�n. <br /> ���5�,�.r.�w <br /> Business Name;�l"ri�i'!____�L°�?'ry=License Number: _�r7. : <br /> Business Mailing Address: oZ/��o LF�("�cN �J���'�'-� l 1�A �'`� 3 <br /> . City State Zip <br /> Phone:,�-'�1(� •-�,�t'� Emaii: i > �/�-� � �c- ' L_51dP��-��'1"�"3� <br /> Cate o � Doscri tion Units Quanti Rate ToUI <br /> Administration Administratlonlmanagement Hours <br /> Labor CGTV Inspection Hours - _ <br /> - gWV Install _ Hours <br /> pipe replacemenl Hours _ <br /> Suriace resloration Hours <br /> Site cieanup Hours <br /> Downspouts/drainage imp Hours <br /> Materials Backwaler valve Per Unil �� - <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feel) Feei �� � <br /> Imported Backfil� Yards <br /> Surface Restoration Materials Lump �� <br /> to soii, rass seed concrete etc. sum � <br /> Cover(irrigation box or load 6enring Per Unil I <br /> cover __�— <br /> Rentals Sp�cify equipment Hour _ <br /> 1 � <br /> Feos �isposal fr.es by item Yards a�-a— <br /> pelivery tees if not covered by labor _ — <br /> Eli ible Total � $ <br /> Other Costs Costs not associated wilh BWD,and <br /> not eligible for robalc (detail below <br /> - vw� � r <br /> vT)4t <br /> 'Tyw.ti <br /> � � � <br /> Ineligi6le Total � <br /> Total ��`�!. <br /> Revised 9/03/2014 <br />