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BACKWATER PREVENTION PROGRAM <br />49e7r INVOICE COST BREAKDOWN 1KI 1 uc,I rQ� <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;,4XpOC,210 6L. e License Number. <br />City State Zip <br />Phone: Email: <br />Cate o <br />Administration <br />Description <br />Administration I management <br />CCN Inspection <br />Units <br />Hours <br />Hours <br />Hours <br />Quanti <br />Rate <br />Totet <br />c7 <br />Labor <br />gSitecleaniupoL� <br />Hours <br />Hours <br />Hours <br />Materials <br />Downspouts / drainage imp. <br />Backwater valve <br />Hours <br />Per Unit <br />(-- <br />_ <br />Grinder pump <br />Per Unit <br />Feet <br />Yards <br />_ <br />Sio sewer pipe (up tr, 8 et) <br />Imported Backfill <br />Surface Restoration Materials <br />(top soil, grass seed, concre 'r61 <br />Cover (irrigation box or oad bearin <br />cover) _ <br />Lump <br />sum <br />Per Unit <br />, <br />O <br />�0 <br />Rentals <br />Specify equipment <br />Hour <br />2J <br />Fees <br />Disposal fees by item _ <br />Yards <br />Delivery fees if not covered by labor <br />EII Ible Total <br />a <br />$ <br />not associated with BWD, and <br />not eli ible for rebate detail below <br />RCostsCosts <br />` <br />Total <br />$ ' <br />1-z& <br />Revised 910312014 <br />