3420 OAKES AVE 2022-05-04 - Laserfiche WebLink

BACKWATER PREVENTION PROGRAM 4W7T INVOICE COST BREAKDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater Prevention Device rebate program. Either this form or your own invoice form with the following line items can be submitted. This allows you to invoice your client according to your existing billing template while allowing city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. Only labor and materials directly related to the installation and function of a backwater prevention device are eligible for City rebate and therefore should be included on the upper half of this form. Additional costs may he added to bottorn of the form. Business Name:gfcrt cSL'5-iL�� License Number: _ Business Mailing Address: L --zl�ryt v-tom rwr� r e_! — = City State Zip Phone:,22�( .', Email:C i lYi it At ar r Category Administration Description Administration / management Units Hours Quanti Rate Total Labor GGTV Inspection Hours L_ 13WV Install Hours _ Pipe replacement Hours Surface restoration Hours Site cleanup Hours _ Ucwnspouts / drainage imp. Hours Materials Backwater valve Per Unit •i' Grinder pump Per Unit Side sewer pipe (up to B feet) Feet t r Imported Back" Yards Rentals Surface Restoration Materials -1!2p soLi grass seed, concrete, etc. Cover (irrigation box or load bearing cover)_ Specify equipment Lump sum Per Unit Hour a —�� Fees Disposal fees by item Yards Delivery fees if not covered by labor —Eligible Total $ Other costs Costs not associated with BWD, and not elf ible for rebate (detail below) 1 Ineligible Total $ Total — — -- - --- -- -- $ a_ aLUJ Revised 910312014