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�------ <br /> - -- , <br /> BACKWATER PREVENTION PROGRAM <br /> IIVVOICE COST BREAKDOWN <br /> Please use this InvoicP Cost Breakdcwn as a template tor invoices submitted as part of the Backwater <br /> Prevention Device rebate progr�m. E.itlier this form or your own invoice form with the following line items can <br /> be submitted. This allows you to invuice your client according to your existinq billing template while allowing <br /> ciry staH to identify how costs eiigible for the Backwater Prevention Device Rebate were accrued. <br /> Onty la6or and materials directfy related to�`he installation and function ofa backwater preven6on <br /> device are eligible for City rebate and therefore should be included on the upper haff of this form. <br /> Additional costs may be added to l�oKom of fhe form. <br /> ,�' 1.�� �L�. <br /> Business Name:�y�'1��-j��� 4� ' c..w; ��SLcense Number. �-�-�.� <br /> Business Mailing Address: o�(c��c L.Gt�1�t� �J uE-�•_ F_�c-csdt__�����.L-3 <br /> City State Zip <br /> Phone:��o'�=/0 '-�l'j� Email: � ' C�.lYk'/'t�a�'�Gian�i S:�I�C�,:�` -f C•cSY�i <br /> Cate o Deseri tion UniLs QuanN RaM Total <br /> Administration Administration f management Hours <br /> Labor CCN Inspection Hours � ,?�j� <br /> OWV��staii Hours <br /> Pipe replacement Hours <br /> Surface restoralion Hours <br /> Site cieanup Hours <br /> Downspouts/drainage imp. Hours � <br /> Materials Backwater vatve pe�Unit ��,�j _ <br /> Grinder pump Per Unit i <br /> Side sewer pipe(up l0 8(eet) _ Feet � i� �' �( �}.d�S s-� � <br /> Imported Backfiil Yards � <br /> Sudace Restoration Materials Lump � <br /> _ to soi�, rg ass seed concrete,etc.? sum ��Q 30 <br /> Cover(irrigation box or load bcaring Per Unit ' <br /> cover _j�__ la ! <br /> Rentals Specify equipment Hour � _ � <br /> q�tli Tv`crC-� — U --- � <br /> � <br /> _ � — i <br /> Fees Disposal tr.es 6y item Y�rcis I <br /> -- - - ------ -- -a�a _- j <br /> Oelivery fees i(not coverecf by labor __ j <br /> ! <br /> EII ible Total .� � • S ' l <br /> Other Costs Cosls not associatecf with BWD,and <br /> not eligible tor rebate (detail below) ___, .._ <br /> F/ lC � �- ^_ FC� <br /> T�n� � 1� ' _ <br /> Ineligible Total ll� J $ � <br /> Total 5 <br /> rP� � <br /> IZ- I�' I'� { <br /> Revised 9/03/2014 � <br /> � <br />