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BACKWATER PREVEIVTION PROGRAM <br /> � INVOICE COST BREAKDOWN <br /> Please use this Invoice Cost Breakdown as a template for invoices submilted as part of the Backwaler <br /> Prevention Device rebate program. Either this form or your own invoice form wilh the following line items can <br /> be submitted. This allows you lo invoice your client according to your existing billing template evhile allowing <br /> city staff to idenlify how costs eligible for lhe Backwaler Prevention Device Rebate were accrued. <br /> Only labor and materials directly relafed to the installation and function of a 6aer�If o�his formn <br /> device are eligible for Ciry rebate and therefore should 6e included on the upp <br /> Additronal cosfs may be added fo bottom of fhe /orm. <br /> c,�,/�,� 5r���,�w ��� <br /> Business Name:��l-�-Lizl�—`'_t------`�"��r�P License Number. �� �'1�--- <br /> Business Mailing Address: o��c LF%c��;� ��-° �—����'�)� ��a��� <br /> City State Zip <br /> Phone:�,(n'�/C�_"v1L� Email:�•fY�(c t��iw�'rran����k1tS.ti�sN�:��L-�7 <br /> Cate o Descri tion Units Qu�nti Rate Totai <br /> Administration Adminislretion/managemenl Hours <br /> i Labor _ CCTV Inspeclion Hours � _- ___'�a- <br /> gWV Install Hours <br /> Pipe replacement Hours _ <br /> Surfaceresloralion Hours — __ _ <br /> �--- Site cieanup Hours <br /> Do�vns�outs/drainage imp. Hours <br /> Per Unit �� <br /> Materiais Backwaler vaWe .'� t S (� f,_�(Lf" �w_ <br /> Grinder pump Per Unit <br /> - Feet �'' �' i��=� <br /> Slde se�ver pipe(up to 8 feel — <br /> Imported Backfill Yards --- <br /> Sur(ace Restoration Materiols Lump U <br /> to son, grass seed concrete etc.) sum �__ �7 <br /> Cover(irrigation box or load hearing Per Unit � <br /> cover — — <br /> RenWls Specify equipment _ Hour <br /> '�i�f� <br /> _-["-1��ztd�-- — <br /> Fees Disposal tec,by item Yards <br /> ��a�---" <br /> Delivery fees i(not covered by labor — -- <br /> -- --. -- --— � - �y 7 <br /> Eli i61e Total <br /> Other Costs Cosis not associated vidh f3WD, and <br /> nol eligibie for rebale detail below _ <br /> Ok a ��+-� _4+Lra4�^ <br /> _��421— --- <br /> — � <br /> � <br /> 5 S 9 /C <br /> Ineligible Total � <br /> Total <br /> Revised 9/03/2014 <br />