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BACKWATER PREVENTION PROGRAM <br /> INVOICE COST BREAKDGWN <br /> Please use this Invoice Cost Breakdown as a template for invoices submitted as part ot the Backwater <br /> , Prevention Device rebate program. Either this form or your own invoice form vrith the following line items can <br /> be submitted.This allows you to invoice your clie�!according to your er.isting biliing template while allowing <br /> city staN to identify hov�costs eligible for the Backwater Prevention �evice Rebate�vere accrued. <br /> Only labor and materlals directly related to the lnstallation and function of a b er half o�hls fo�mn <br /> device are eligible for Ciry rebate and therefore should 6e incfuded o . �ne upp <br /> Additional costs may be added to bottom o(the form. � <br /> J������ _�t7�j�1-1 <br /> P�siness Name:Q✓YlP_,r!�����2-�'�-L�'�P�'cense Number: <br /> Business tvlaiiing Address: o�� ���'� `J�e" �-�l�'��� �y��,3 <br /> City State Zip <br /> Phone:;�.�•• c� ..• S Email:(�}f1-�(C)nm�r�ircznS�� ��r�n�LS'r1PSNc�2' .�' i'� <br /> Des�ri tion Units �uanti Ratc Total I <br /> Cateyory HourS <br /> Administration Administration I management Hours �� <br /> Lahor CCTV Inspeclion Hours <br /> gWV Inslall <br /> Pipe replacement Hours <br /> Surface restoralion Hours _ � _�� <br /> Site cteanup Hours <br /> Downsoouts I drainage imp. Hours <br /> Backwater valve Per Unit { � <br /> Materials Per Unil <br /> Grinder pump - ��,�� <br /> Side sewer pipe up to 8 teeq Feet ���i� <br /> �mported Backfill Yards <br /> Surface Res�oralion Materials Lump l �� .�;� <br /> _to soil qrass seed,concrete etc. sum -�-- <br /> Cover(irrigalion box or load bcaring Pcr Unil —��—�� <br /> coverJ__� Hour — <br /> Rentals Speci(y eqwpment — 3� <br /> ��L��'� ' � - <br /> `_— _�o��?� <br /> Disposal fecs by ilem _�^ Yards ---� -- <br /> Per.s _. <br /> Uelivery tees if nol covered 6y labor ___ — <br /> - -- - . l� r� - - . � $ � <br /> Eli ible Total � <br /> other Costs Costs not associated with BWD,and — <br /> not eligible for rebale dotail below _ <br /> _ , ro o �.�� Qt.ro w U 4JJ <br /> 1� <br /> — ,r i.v�W.tf <br /> fo ZL 1S <br /> S <br /> Ineligible Total g <br /> Total <br /> Revised 9/03/2014 <br />