Laserfiche WebLink
BACK'�NATER PREVEIVTION PROGRAM <br /> INVOICE COST BREAKDOWN <br /> Please use this invoice Cost Breakdown as a templale for invoices submitted as part of the Backwater <br /> Prevention Device rebate program. Either this form or your own invoice form with the foGo�ving line items can <br /> be submitted. Tliis allows you to invoice your client according to your existing billing template while allowing <br /> city staft to identi`y hova costs eligibie for tne Backv�ater Prevention Device Rebate were accrued. <br /> Onl��fa6or and mate�i.31s directly relatea to the instaUation and funr,tion of a backwaterprevenfion <br /> device are eligible ►or City rebate and tl�erefore shou/d 6e included on the upper half of this form. <br /> Additional costs may be added to boftom of the /orm. <br /> � _. . ,- �,� <br /> J`'`�` � -D�� <br /> 9usiness I�ame:A��C�>>'� �'���-�=��r�e License Numoer: <br /> Businessh4ailingAddress: o��o L.Gc���[� OJt�-• 1=�c,'—I�G'f`� �,��� ��`���3 <br /> City State Zip <br /> Phone:�:,(o'�fC� -�,�'7,_� _ Email:�'i��n �r n��__,-��r3nl}_.7,debYc,2°� �'� <br /> , C,gory Deseri tion Units Quanti Rate iotal <br /> j Administration Administralion I management � Hours <br /> ��Lahor CCTV Inspec!ion Hours " �"� <br /> gWV Install Hours <br /> Pipe replacement Hours <br /> � Surtar.e reslora�ion � Hours <br /> Si;e cleanup Hours <br /> Downspouts I drainaoe imp. Hours � � <br /> Materials Backwaler vatve Per Unit 1 � <br /> Grinde�pump Per Unit <br /> Side se�ver pipe(up to 8 feet) Feet ;L�-��.�-( �� aGf-� oZ � <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> _(t� soil, grass seed concrete, etc.) sum �L7— �.— <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) r a ._L <br /> Rentals SpeciFy equipment Hour <br /> — � �J� <br /> FP.QS I Disposol fees by item Yards — <br /> ' j Delivery fecs i(no�covcrcd by la6or � <br /> Eli ible Total � � $ <br /> Othcr Costs Cosls not a:,sociated v�ilh tiWD,and <br /> no�eli ible for rebate delail belov� _ <br /> —{-- — <br /> v <br /> - -- -- � — <br /> _—� _ S <br /> y -- <br /> i I <br /> Ineligible Total 4/ 4 l7 <br /> To[al — a <br /> Revised 9/03/2014 <br />