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BAGKWATER PREVENTION PROGRAM <br /> � INVOICE COST BREAKDOVNN <br /> Please use this Invo�ce Cost Breakdown as a template for invoices submitted as parl of the Backwater <br /> Prevention Device rebate program. Either this form or your own invoice form with the following line items can <br /> be submitted. This allows you lo invoice your client according to your existing billing template while al:owing <br /> cily statf to ideNify hov�costs eligible for the Backwater Prevention Device Rebate were a�crued. <br /> Only labor and materials directly relafed to the installation and function of a backwater prevention <br /> device are eligible foi City rebate and therefore should be included on the upper half of this form. <br /> Additional costs may be added to bottom of the form. <br /> ..�:� o <br /> E3usiness Nome;�'/'<'� �.. � ` P�Li�se Number: _{�J�i���'` <br /> Business Maiiing Address: o��� L.Ec I'����l iJ�� -��''�'� r.�JA 0��t�� <br /> City State Zip <br /> Phone:, �`—"X��> --� �'� Email:�C �' ilY1CCi«z����"'� ��•1 S'ri�tN-�Y(: C'c� <br /> Categ� _ Descri tion _ Ur.its �uanti Rate Total <br /> Administration Adminislralion I rtianagement Hours _ _ <br /> Labor C�N Inspeclion Hours <br /> gWV Install Hours <br /> Pipe replacement Hours <br /> Surface resloration Hours _ <br /> Site cleanup Hours _ <br /> Downspouts f drainage imp. Hours <br /> Materials Bachwaler valve Per Unit �� �(}Q�-� �___ <br /> Grinder pump Per Unit <br /> 'ide sewer pipe(up to 8 teet Feei � � <br /> Imported Back511 Yards <br /> Surface Restor�tion Mate�ials Lump <br /> to soil,grass seed concrete,et� sum � �3� '�� <br /> Cover(irrigation box or load bearing Per Unil � � !� <br /> cover _ <br /> Rentals Specify equipment� Hour _ — <br /> � <br /> Fees Disposnl (ees by ilem _ Yards __ <br /> a - <br /> Delivcry tees if not covr.rod by labor _ <br /> Eli ible Total � $ <br /> Other Costs Cosls not associated wilh BWD, and <br /> not eligible tor rebate detail below <br /> �„ 0.�Gc <br /> � � <br /> �u� <br /> !c. a// . <br /> Ineligible Total � � <br /> sa <br /> ro�a� <br /> Revised 9/03/2094 <br />