Laserfiche WebLink
BACKWATER PREVENTION PROGRAM <br /> INVOICE COST BREAKDOWN <br /> Please use this Invoice Cost Breakdo�vn as a template for invoices submitted as part of ihe Backwater <br /> Prevention Device rebate program. Either this form or your own invoice form with the following line items can <br /> be submilted.Tliis allows you to invoice your client according to your existing biiling template while allowing <br /> city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br /> Only labor and materials direcGy re/ated to the installation and function of a backwater preven6on <br /> device are eliglble for Ciry re6ate and therefore shoufd be incfuded on the upper half of this form. <br /> Addifional costs may be added to 6ottom of the (orm. <br /> 5�,�� �t.�. /' <br /> Business Name:,��j���_.�c._c�-5;f�e License Number._QS?�,�"1"� <br /> Business Mailing Addrass: i��r'tilc LCc/'%Vl C.l��-• rf��?� _._l.v.� ���t� <br /> City State Zip <br /> Phone:,��'�lc? "�.7'�_:�l___ . Email:(��>nm�ri�an�/�1}i�r)n�S;d�S�;,Y°� C'cSYY] <br /> Cate o Descri tion Units Quanti Rate Total <br /> Adminis[ration Administration/management Hours <br /> Labor CCTV Inspection Hours ��'� <br /> 8WV Install Hours <br /> Pipe replacement Hours _��� _ �_ <br /> Sudace restoration Hours <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Materials Backwaler valve __ __ Per Unit � ���6�/� _�_ _ <br /> Grinder pump Per Unit <br /> Side sewer pipe(u to 8 feel) Feet �� �� � <br /> Imported Bac�ll Yards <br /> Surfaco Resloralion Materials 1_ump <br /> to soil rass seed,concrete,etc. sum � �O <br /> Cover(irrigation box or load hearing Per Unit � <br /> �o�e��_ _�, r� a —_ I <br /> Rentals Specify eq0ipmenl Hour <br /> -�'�-�` � ---- -�-- ---��'�2€� _�2r2 j <br /> -__ ! <br /> Fees Dispos�l fees by ilem _ __ V�rds � ' <br /> ---- � -- — _ . <br /> i <br /> ----- — — — -- -----__ _ I <br /> _ _ ___ Delivery fees i(not covered by la6or _ __ _ _ __ <br /> Eli ible Total ' i $ , <br /> Other Casts Cosis not associated�vith BWD,and <br /> not eligible for rebate(detail belo�v_ __ __ <br /> — -- - i <br /> - t <br /> _._ 9� � <br /> µ ��� IG��'' <br /> ���� <br /> IneligibleTotal $ `I7GI��' � <br /> Total $ <br /> Revised 9/03/2014 <br />