2607 ROCKEFELLER AVE 2022-05-12 - Laserfiche WebLink

� � � ��o��[�c�� r1vo� ce G�s-� ��e�ck��o�n1 � P ase use t is Invoice Cosl Dreakdor�n as a template for invoices submitted as part of 1he ac water Prevention Device rebate program. Edner lhis form or your own invoice form ��ith tho following line items ca� be submitted. This allows you to invoice your �Ilent according to your existing billiny template while allowing city sfatf to idenNfy 11ow Costs eligible for the Backwater Prevention Device Rebate were accruad. Onfy fabor and materials dlrectly related to the instaflation and fimction of a backwater prevention device are ellglble for' City rebate and therefore shoufd be includad on ihe upper half of thrs form. Atldldonai costs ma}� be added to bottom of the form. Business Name:�'_�i� o� cu�c�X�«k __ License �umber:/-�vs��sv /-�'.�S Business i��idif�ng Atldress �l1LS��b�i��J_� �^��S �• �8�a6 //� /�I/ City p Stale �+� Z��p . . Phone:_ �" - v—f l�� __ Email:Yll�r"�w��S�o2,�� Av�cYSG_'K1� �1�"�u r. Go�� �-Labor — � t- I �9atcrials I � l- -�._. I � �-- I Rentals F--- � Fces Eliqible Total OQier Costs �nofiqibic Tofa� Total CCTV In;pE BV�N InstaU Bac'tr:a,er valve Gr:nder pu� Side sewer pipe (up l0 8 feet) hnported Backiill �� Surface Resroration ��iateria!s to � soil grass seed. concrete Cover (irrigalion box nr load b Hours Hours Hours Heurs Hours Ho�ars Yards Per Disposal (ces by item _,___�.__ � Ta�u' � Delivery fces i( not covered by labo�_ __ __ � — - — - _ ------ -- l - I Costs not assoaaled vn�h BWD, and I nol eli ible for rehale (detail helov�.�_,.,, ___ Revised 9;03�?01�# � �u- V �rI�7 �-_ __ _I _ - — - -j1�0.� � ��— ---..__ __ �� . ��.t%dR— --- -- ---- _ � l d" --- i s