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BACKWATER PREVENTION PROGRAM <br />4a-rTINVOICE 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 e,,isting billing template while allowing <br />city staff to identify how costs eligible for the Backwater Prevenlinn Device Rebate were accrued. <br />Only labor and materials directly related to the in: tallat;on and function of a backwater prevention <br />device are eligible for City rebate and therefore sho:,!j be included on the upper halt of this form. <br />Additional costs m y be a ded to bottorn of the form. <br />% <br />Business Name: ), e-re License Number: AkoISS P f \s <br />Business Mailing U2; ,�kf,+f' <br />S* 90 <br />�li r { L`4 <br />(/Afddress: <br />Phone: V1b5 <br />Email: Axo%i{�G�S�aClRmtt-J,Seul� <br />y State <br />Category <br />Description <br />Units <br />Quantity <br />Rate <br />Total <br />Administration <br />Administration / management <br />Hours <br />a <br />Labor <br />CCTV Inspection <br />Hours <br />BWV Install <br />Hours <br />r <br />+ <br />Pipe replacement <br />Hours <br />Q 00 <br />IP5,0100 <br />Surface restoration <br />Hours <br />Site cleanup <br />Hours <br />Downspouts / drainage imp. <br />Hours <br />Materials <br />Backwater valvr. <br />PerUnit <br />09,CC2 <br />(7,t <br />Grinder pump <br />Per Unit <br />Side sewer pipe (up to 8 feet) <br />Feet <br />Imported Backlill <br />Yards <br />Surface Restoration Materials <br />((op s ' r ed, concrete etc. <br />Lump <br />sum <br />Cover irrigation bo or load bearing <br />cover <br />Per Unit <br />I <br />o ,Or9 <br />0. 00 <br />Rentals <br />Specify equipment <br />Hour <br />Fees <br />Disposal fees by item <br />Yards <br />p, <br />, CU <br />Deliviry fees if not covered by labor <br />, OO <br />04A,0 <br />Eligible Total <br />,GYM <br />Other Costs <br />Costs not associated with BWD, and <br />not eligible for rebate detail below <br />_Q l� ha <br />a. LOAKI <br />lL7HWf/ <br />ti <br />z z rt' <br />Ineligible Total <br />$ <br />Total <br />$ <br />Revised 910312014 <br />