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BACKWATER PREVENTION PROGRAM <br />04;�� INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breatdown as a template for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this farm or your own invoice form with the following line items can <br />be submitted. This allows you to invoice your c , nt according to your existing billing template while alloying <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 of re nt ion <br />device are eligible for City rebate and therefore should be included on the Epp <br />n. <br />Additional costs rnay be added to bottom of the forrn. W` L C- , <br />q <br />'.P <br />Business NameAoe ���1-1 'so 1C��SLicense Number: <br />Business Mailing Address: <br />State Zip <br />ZY jp .•vy�'� Email: ( nin�/rr�znS�llii�i�i» SriPS'a,.et(-`i[ .) <br />Phone:��. <br />Cate o <br />Description <br />Units <br />Quantity._Rate <br />Total <br />Administration <br />Administration / management <br />Hours <br />Labor <br />CCTV Inspection <br />Hours <br />BWV Install <br />urs <br />Pipe replacement <br />urs <br />- <br />Surface restoration <br />urs <br />Site cleanup <br />urs <br />lHours <br />Downspouts I drainage imp. <br />Materials <br />Backwater valve <br />r Uoil <br />0_r��t,1Grinder <br />pump <br />r Unit <br />Side sower pipe (up to 8 feet) <br />Feet <br />' " <br />a4H <br />Imported Backfill <br />Yards <br />Surface Restoration Materials <br />Lump <br />3 f] <br />to soil, grass seed, concrete etc. <br />sum <br />Cover (irrigation box or load bearing <br />Per Unit <br />a <br />I a <br />cover <br />Rentals <br />Specify equipment <br />Hour <br />Yards.�� <br />Fces <br />Disposal tees by item <br />Delivery tees if not covered by labor <br />S <br />Eligible Total <br />a <br />Costs not associated with BWD, and <br />Other Costs <br />not eligible for rebate (detail below <br />-- - - <br />- - <br />(a loft CA <br />A <br />l w.bAll <br />S <br />Ineligible Total <br />Total'�- <br />Roviscd 910312014 <br />