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BACKWATER PREVENTION PROGRAM <br /> INVOfCE COST BREAKD4WN <br /> Please use this Inu6iCe Cost Breakdotvn as a template for invoices submitted as part of the Backwater <br /> Prevention Device rebate program. Either this form or your own invoice form with the following line iten�; . •ir <br /> be submitted. This allows you to invoice your client according to your existing billing template while allowing <br /> city st�N to identify how Costs eligibte for lhe Backwater Prevention Device Rebate were accrued. <br /> Un/y Jabor and materials direct/y relafed to the installatron and function of a backwater prevention <br /> device are ellgible for City rebate and therefore should be included on the upper haff of this form. <br /> Additionaf costs may be added to boftorn of the form. <br /> Business Neme:�o � L�V�1' —`t'v�� License Nu ber;/ 1��.1-�— <br /> Business Mailing Address: � ��� -s��' ��'� �" ✓'g�' <br /> / ' � � Cityy tate Zip <br /> Phone: <br /> ��yID7'L���.__Email: �'hr'��c�uGSOv'ef�� �Q/+�Jeci�,CoM <br /> Cate o Descri tion Units Quantity_ Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours <br /> BNN Install Hours <br /> Pipereplacement Hours � ,00 �� ��� <br /> Suriace restoration Hours <br /> Site cleanup Hours <br /> Downspouls/drainage imp. Hours <br /> Materials BackwatP�valve PerUnit Q�.GD `..1�D �00 <br /> GriiidAr pun�p Per Unil <br /> Side sewer pipe(up l0 8 feet) Feet <br /> � Imported Backfill Yards <br /> Surtace Restoration A4aterials Lump <br /> to soil,c rass.seed concrete,elc,) sum <br /> Cover irrigation box r load bearing Per Unit � r�D.� ar� O� �_ I <br /> CnVer <br /> o� l,l,l <br /> Rentals Specify equlpmenl Hour <br /> Fees ! Disposal fees by item_ Yards /� _ <br /> r-•— <br /> Delivery fees if not covered by labor `'•�.�L_— � �� �O <br /> - �03� � .S <br /> Eli ible Total � � 1 <br /> Other Costs Costs not associaled v�ith BWD,and <br /> no�eliqible for rebate(detail below) <br /> _..C�G4. Iv x conr,uc � �fi..uo �., v "34t 1 <br /> , �k� <br /> /,..b[{ � <br /> — —. --- _'_ ,_-�s.r-- � � 1 <br /> Ineligible Totzl $ <br /> Tofal — $ <br /> Revised 9/03/2014 <br />