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BACKWATER PREVENTION PROGRAM <br /> ' j BREAKDOWN INVOICE COST <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 to 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 the upper half of this form. <br /> Additional costs may be added to bottom of the form. <br /> Business Name: A--P/&,nbi ri: C i C License Number: j--i-I / *'l)1/,Oi <br /> Business Mailing Address: 'p,6// CcS '' Az& 9 t 8 <br /> _ City State,} Zip <br /> Phone: �-s ` b?-01 z 3 Email: /' -/41t fii oi�'�-y /rr'(' e ( i!?rr+ ib.e <br /> Category Description Units Quantity Rate Total <br /> Administration Administration I management Hours <br /> Labor CCTV Inspection Hours / '3 a 7 <br /> BWV Install Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours / 2 5 ° <br /> Site cleanup Hours / / 5--t) <br /> Downspouts I drainage imp. Hours <br /> Materials Backwater valve Per Unit S—E) <br /> Grinder pump Per Unit 4 <br /> Side sewer pipe(up to 8 feet) Feet <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil,grass seed,concrete, etc.) sum I �7 <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards <br /> p-en4A-L-f -3 <br /> Delivery fees if not covered by labor <br /> Eligible Total $ <br /> Other Costs Costs not associated with BWD, and not eligible for rebate(detail below) 14 9, <br /> t� 7� *5 0 <br /> Ineligible Total $ -1 LTotal $ <br /> Revised 9/03/2014 <br />