3502 ROCKEFELLER AVE 2022-05-12 - Laserfiche WebLink

4' BACKWATER PREVENTION PROGRAM INVOICE COST BREAKDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater Prevention Device rebate program. Either this form or your own invoice form with the following line items can be submitted.This allows you to invoice your client according to your existing billing template while allowing city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. Only labor and materials directly related to the installation and function ofa backwater prevention device are eligible for City rebate and therefore should be included on the upper half of this farm. Additional costs may be added to bottom of the form. Business Name: An-P/wn bt/Z LL C License Number: 61)--plujittlfieo Business Mailing Address: got iti 5tarainAct. t illi' vapecr 9sm `-"de) Phone: 4 — ""®tZ j�>3 Email: -pIL�Y3'1 1f �Lt� Onnii. 'L ►c 4Y7 Category Description Units Quantity Rate Total Administration Administration/management Hours Labor CCTV Inspection _ Hours / BWV Install Hours / /Z5 C) Pipe replacement Hours Surface restoration Hours r , 25) Site cleanup Hours f _I S Downspouts/drainage imp. Hours Materials Backwater valve Per Unit I 2- > C) Grinder pump Per Unit Side sewer pipe(up to 8 feet) Feet Imported Backlit) Yards /ri`'e Surface Restoration Materials Lump (top soil,grass seed,concrete,etc.) sum Cover(irrigation box or load bearing Per Unit cover) Rentals Specify equipment Hour Fees Disposal fees by item Yards AftWL/61--- Delivery fees if not covered by labor Eligible Total $ 2 2r1 Ste_. OtherCosts not associated with BWD,and Costs not eligible for rebate(detail below) inelipitnle Total $ 2IN _...-_ o. Total $ Revised 92014