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BACKWATER PREVENTION PROGRAM <br />4wrr INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Either this form or your own invoice form with the following line items can <br />be submitted. This allows you to invoice your client according to your existing billing template while allowing <br />city staff io identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only labor and materials directly related to the installation and function of a backwater prevention <br />device are eligible for City rebate and therefore should be included on tire upper half of this form. <br />Additional costs may be added to boltoin of the form. ni 1 Ylr ' '.— <br />Business Name:��J$f�ltie pF9 �r1L� y117/�� I License umb(eer:NJ <br />Business Meiling Address: 2 S t�� �57 1s Uri <br />ty <br />Phone: 0A L' Email: Sa u o ci waH I <br />Category <br />Administration <br />Description <br />Administration I management <br />Units <br />Hours <br />Quantity_ <br />Rate <br />ToLaI <br />Labor <br />CCTV Inspection <br />BVVV Install <br />Hours <br />Hours <br />Pipe replacement <br />Hours <br />Surface restoration <br />Hours <br />Site cleanup <br />yHours <br />Hours <br />Per Unit <br />fib <br />0�. _ <br />Materials <br />Downspouts I drainage imp. <br />Backwater valve <br />Grinder pump <br />Per Urtlt <br />Side sewer pipe (up to 8 feet) <br />Feet <br />Imported Backfill <br />Yards <br />Surface Restoration Materials <br />to sn' ss eed concrele, etc.).sum <br />Lump <br />_ <br />Cove irrigationbo rloadbearing <br />COvef <br />Per Unit <br />�Or00 <br />�nr�n <br />�rVv <br />{� <br />eC0•00 <br />Rentals <br />specify equipment <br />Hour <br />Fees <br />Disposal fees by item <br />Delivery fees if not covered <br />Yards <br />' <br />$ _ — <br />EII ibla Total <br />Other Costs <br />costs not associated with BWD, and <br />not eligible for rebate detail below <br />—_ <br />h-ccchrf <br />47" <br />(! t-o <br />cc <br />u �r U1 <br />hroligible Total <br />l <br />^' r'r <br />Total <br />I <br />Revised 910312014 <br />