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Backwater Pre��ention Device <br />Rebate Program <br />Invoice Cost Breakdown <br />l��r��i'¢# <br />u � s�i-ai3 <br />Please use this Invoice Cost Breakdo�vn as a template for invoices submitted as part of the Backv�ater <br />Prevention Device rebate program. Either this form or your own invo�ce form with the following line items can <br />be submitted. <br />Only la6or and materials directly related to the installation and function of a backwater prevention <br />device are eligible fu� City rebate and there%re should be included on the upper half of this /orm. <br />Addrtional cosfs m�y be added to b�ttom o( fhr. form. <br />T�ZCdµtia��tor5,�-« l�r�.� jMzcocr.is58'PR � <br />Compariy Name: I 4" 4d� e u/�✓� •(�D3- h3,8�0_0 Date: // -�1� /5 _ <br />ccFo/est r � wq 4��5 <br />Property Address: � 6 � � IQoc%F�.11t I ��vC �VC��(��D / <br />Gategory Description Units �uantity Rate Total i <br />Administration Administration / management Hours !?S _� UO <br />La6or <br />CCTV Inspeclion 1 Hours /Lb �,j/DO <br />BWVlnstall Hours Q26^ SZ6 <br />Pipe replacement Hours <br />Surfacerestoralion �Hours � 3U�' 43c�a <br />Site cleanup � Hours � 3fl� t. 3e�C <br />Downspouts / drainage imp. Haurs <br />Materials <br />�ac.l�vater valve Per Uni� � 200 200 <br />Grinder pump Per Unit <br />Side se�ver pipe up l0 8 feet Feet _cJ �/U S'D <br />Impor;ed Backfill Yards <br />Suriace Restoralion Materials Lump � d 2�� � 2n <br />�e soil, grass seed concrete, etc.) sum '� <br />Cover (irrigation hox or load bearin� Per Unit ' d 5.�� ,�S-� <br />cover) •-P <br />�Rentals Specifyequipment ___�_, <br />CL U- �_J_(` 2 7F Iiacr � /?.0 2t� --- <br />Fees Dis osal fees by item Yards _( ��i.0 (00 <br />Delivery fecs if nol eovered by labor __ <br />other__ � SE�,�t=_�'�".� _— � �O l�3[� <br />Eligibi+: Total $ 'ZZE'6 <br />Other Costs Cosls nol associated wilh BWD, and 1 1 <br />not eliqible for rebate � fail below __, __ ___ <br />Ineligible Total 5 <br />�suteae,i 5 22b'G <br />Tax 9.2°10 5 fo J- <br />Total $ 2 � <br />Revised 1?J11/2014 <br />