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BACKWATER PREVENTION PROGRAM <br />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 biliing template while allowing <br />city staff to identify how costs eligibie for the Backwater Prevention Device Rebate were accrued. <br />Only labor and materrals direetly related to the installatfon and f�nction of a backwater prevention <br />device are eligibfe for C►ry re6ate and therefore should 6e included on the upper half of thls form. <br />Additional costs rr�ay be added to bo�to� f the /orm. <br />fii�" �r`i c�un �E��..� a- ��8 <br />Business Name: S�� P SP��� License Number. _ <br />Eiu ;iness Maiiing Address: <br />Phone:��i�-�4O- a <br />Revised 9/03/2014 <br />