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BACKWATER PREVENTION PROGRAM <br /> � INVOICE COST BREAKDOWN <br /> Please use this Invoice Cost Breakdown as a template tor invoices submi;�ed as part of the Back�vater <br /> Prevenlion Device rebale program. Either this form or your o�vn invoice form with the following line items can <br /> be submitled. This allows you to invoice your client accorcling to your existing billing template while aPoe;�ing <br /> ciry staK to identi(y ho�v costs eligible for the Backwater Prevention Device Rebate were accrued. <br /> Only labor and materials directly related to ihe installation and function o(a backwaterpre �ention <br /> device are eligible for Ciry rebate and iherefore should be incJuded on the upper half of this rorm. <br /> �dditional costs rna}�be added to botfom of tlte form. <br /> Business Name: �o+�rNWtsr l,�yx�+���QE License Nmnber: .N����T �� �75L5 <br /> BusinessMailingAddress:�� � �a� lCa7 ��,�i,��,�,.� C}-S'� �J�.�as_ <br /> City� State L�N <br /> Phone:�25 ?,a 'f� d$'S� Einail:J�lcr�Lr�tRas��t,,v4�C.¢ (y'<�p�tn,; , Go�+ <br /> Categ� DescriPtion Units Quantit Rate Total <br /> Administretioo Administrationlmanagemenl Hours 2+7f� uoed �1 / GJ <br /> Labor CCN Inspection Hours N � <br /> BNN Install Hours �/ / / 0 "O ,f/�/ 0 — <br /> Pipe replacement Hours J ,� „�M i�o � � �u."= <br /> Surface restoralion Hours �? .�,��t �5 •'° ,�! 24,5 °= <br /> Silecieanup Hours 2, :�170 ,;'� /ua:-� <br /> Downspouls I drainage imp. Hours N(n <br /> Materials Baclnvatcrvalve Per Unil � �J.�7 S°-y � 'J.,�$="— <br /> Grindcr pump Per Unit �� h <br /> Side se�ver pipe (up to 8 feet) Feet u # �(�,v� 4 tj 7�on <br /> _ Imporled Backfil Yards �'1 �� � / `� y� �]?�'— <br /> Surface Resloralion Malerials Lump }� i �; ,� �, <br /> ___(top soil,grass seed,concrete, etc.) sum Jv `�.00 ' ,� 2eo - c� �,00 <br /> Cover(irrigation box or load bcarinp Per Unil o„ �� <br /> cover) 1 ;J� f 5� - $l / So - <br /> Rmrtals Speci(y equipmenf Hour � q . <br /> Fees Disposal lees by item Yards �( f S `= �6 ( �JO �� <br /> _�5------ <br /> _ a r� <br /> _ _, Delivery fees il not r.overed by labor 0�� w y cr�++�c �.,, t'_4PS _ __ <br /> _ _ --- -------- <br /> Eli ible Total y Soo� <br /> Cos�s nol associaled with RWD,and <br /> OtherCosts {I���- k.��bu�� <br /> _ not r.ligible for rebale(delail below) �� �� _ _ <br /> eo�n�r.<..,:- ��sT�- - --__�5 ��. •16G5°" .12�-�— <br /> Incligible Total �y 2?.�S�'Y� <br /> Tot,� I__ � y Z�_5 � <br /> Revised 9/03/2014 <br />