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Backwaier Prevention Device <br />`� Rebate Program <br />Invoice Cost Breakdown Pe;�`",f #- u�s��-��s <br />Please use this Invoice Cost Breakdo�•• n as a template for invoices submitted as part of the Backwater <br />Preventiun Device rebate program. Either this form or your o�vn invoice form vaith the following line items can <br />be submitted. <br />Only labor and materials directly �elated to the installation and function of a backwater prevention <br />device ara eligible (or Cit}� re6ate and fherefore should be incfuded on the upper half of this form. <br />Additional costs may be added fo bottom ol �he formi. <br />-r ���,a# ��uzcoc�gSyPR <br />CompanyName�M�Cv�f/ac�pYS,LLG u81 � too3:5z8h%.o� Dafe: ��'�'l'15 <br />�� _ �o �.—.r-r _ _ �> <br />PropertyAddress: � �' �7 ���� �e (� �Y/�VQ ., �V2 <br />Category Description Units Quantlty Rate Tuial <br />Administration AdminisiraGon 1 managemenl Hours 2 � 7S CL�?- <br />Labor <br />CCTV In,pection Hours I � }/�'� K��0 <br />D4VV Install Hours 2co 600 <br />Pipe replacemenl Hours � <br />Surface restoration Hours I j 300 � 3;.�v <br />Sile cleanup Hours I 3 O ioJ <br />Downspouts / drainage imp. Hours <br />Materials <br />Backa�ater vslve Per Unit z, 2e� 4Do <br />Grinder pump Per Unit <br />� Side se•.ver pipe (up to 8 feet) Feet _'7 /U $ 7c7 _ <br />Imported Back(ill Yards <br />Surface Resroration Malerials lump � � Z�i � ��� <br />lo soil, rass se:ed, concrele, elc. sum <br />Covar (irrigalion boz or load bearing Per Unit -� � 5-p d f��� <br />cover _ �� <br />Rentals Specify equipment _ <br />C c'r� _>f��%� CANIFR� Hour � 1 /2O /z�i <br />Fees Disposal fees by item Yards <br />Delivery fees if not covered hy labor <br />Other s; J f Se�,��r (Sin�t 1 d 3u �3;' <br />EligibleTotai S Z;qo <br />Other Costs Cosls not associated with B�VD, and <br />not eligible for rebate (detail below) __ <br />Ineligible Total 5 <br />Subtotal 5 Z290 <br />Tax 9.2%) $ zlv o�.�Z— <br />—� _ _ Total_ ��� <br />Revised 12/11/2014 <br />