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Backwater Prevention Device <br />E" Rebate Program perw��+ � <br />u15�� -003 <br />Invoice Cost Bre�kdown <br />Please use this Invoice Cost 6reakdown as a template for invoices submitted as part ot the Backwater <br />Prevention Device rebate program. Either this form or 7our own invoice form with the Follo�ving line items can <br />be submitled. <br />Only labor and materials directly related to the installation and lunction of a backwater prevention <br />device are eligible for City rebate and there%re shou/d be included on the upper half of this form. <br />Additional costs may be added to bohom of the form. <br />Compar,yfJame: �MZ Cu�id�•+1���'S L�-L L'��1� ����ZcoG�"�ti� ate: 11- `i—�5 _ <br />ItS3}Nr�l'.4r�.vE,N�h�n�l U41 Gi'S-52q-7-�'c' <br />ProperiyAddress: � �°`I RO"ck��iitr�ve. �t;Ver�t, �vA a�zv� _ <br />Category Description Units Quantity l Rate Total <br />Administration Administration! management Hours � �J / Z � �' SC�� <br />Labor � J <br />Materials <br />Rentals <br />Other <br />Other Costs <br />CCTV InspecUon <br />B�VV Install <br />Pipe replacement <br />Surface restoration <br />Site cleanup <br />Downspouts / drain, <br />Backwater valve <br />Grinder pump <br />Side se�ver pipr. (up <br />Imported Backfill <br />Surlace Restoralion <br />(top soil, grass seec <br />Cover (irrinalion box or <br />� <br />Hours � vC � /oo <br />Hours �2 2E3 S2G <br />Hours <br />Hours I 3�0 � ���� <br />Hours I 3 CU � 3�'� <br />Hours <br />Per Unit t 2ae� zrn <br />Per Unit <br />Feel $ 1 U ¢ 4 U <br />Yards <br />GC i V C�iM F rz q-� Ft�E�2 �_�our <br />]isnosal fees bv ilem Yards <br />Revised 1?J11/2014 <br />fees if not covered <br />not associated with BWD, and <br />�ihle for rebate Idr,tail belowl <br />� :� o �, z_ o <br />c� s U � s �� <br />� — -- <br />� Zp _ �2�� <br />�— -- — <br />� 100 I �� <br />� Eligible Total <br />J�t F� �n^4 cc...I.T. <br />a <br />3D <br />z2.�t6 <br />h„iv.y�.. c <br />IncligibleTo!al 5 �� It, <br />Subtotal 5 L ,z f�b <br />Tax (9.2%)—+I S 'z 1 U, il _ <br />Total I$ 2 4 96 . 3� <br />M�� <br />