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BACKWATER PREVENTION PROGRAM <br /> E INVOICE COST BREAKDOWN <br /> Please use this IrivoicE Cosl Breakdown as a template for invoices submitted as part of the Backv�ater <br /> Provantion Device rebate program. Either this form or your own invoice form with the follovring line items can <br /> be submilied. This allows you to involce your ciient according to your existing billing template while allowing <br /> city staff to identify ho�v costs eligible fcr the Dackwater Prevention Device Hebate were acr.rued. <br /> Only/abor and materials drreetly related tu the insfallation and/unction of a backwater prevention <br /> deVice are ellgible forCity rebate and therefore should be included on the upper half of this (orm. <br /> Additional costs may b��dded fo boftom o(the tonn. <br /> �p uft',�r��, ���ss ���...� 5 <br /> Business Name:uv�d. �-�'we License Number. \ <br /> Bitsiness Pdiailing AdJress:��._��i� JI '5•�, �K��� " -' ' ���� <br /> '/� �1�-7�"`�—`a/lc�+ � � Zlp <br /> Phone:���(�7�"' ���3 Email:� S f�T2�a IC P,2-Ql.1�P�_�.��_ <br /> Cate o _ Description Units Q antity_ Rate TuWI <br /> Administration � Adm!nistration 1 managemenl Hours _ _ <br /> Labor CCTV Inspection Hours _ ___ <br /> E�WV install Hours <br /> Pipe replacement Hours <br /> � surtace restorat�on Ho�'�� O GU` aS�•Q� <br /> Site cleanup Hours . <br /> Downspouts I drainaye imp. Hours _ _ <br /> Materials Backv:a�er valve Per Unit ,b0 �`�•DO <br /> --- Grind6r pump Per Unit _ _i <br /> Side sewer pioc(up to 8 feel) Feet <br /> Imported Backiill �'ards _ <br /> � Surface Restoration telaterials lump <br /> toP soil,grass seed_co elc sum _ <br /> � � � Cover(irrigalion hox load hearing Per Uni� � ^^� O-�� <br /> cover) _ -��'�� <br /> Rentals Sper.ify equipment _ Hour _ _ ____ <br /> Fees DisUosal fees�y item Yards ,� ,00 _ao• � ___ <br /> Delivery fees if not r.overed by labor __s�A ; a�0• 00_ <br /> r <br /> ___._-_-_.___ �. � <br /> Eli iblo Total --- ----- - ��-- — � — ^: _ �.O <br /> Olhcr Costs Cosis nol associated eiilh OWD,and <br /> not eli ible for rebate delail below __— <br /> �-- — _—._��._— <br /> --- __n� w lo� �a.��a rvr �...�,..i�. <br /> _._ -- 34 ---_ — <br /> ---- -- -��-�.""^- i <br /> -----�"-' - - IIR.� IG.�.,bnil <br /> Inelic�ible Total � <br /> Total __ — � <br /> Revised 9/03/2014 <br />