1125 WETMORE AVE 2022-05-17 - Laserfiche WebLink

BACKWA�'ER PREVEIVTION PROGRAM � INVOICE COST BREAKDOWN Pleese use this Invoice Cost Breakdown as a temp�ate for invoices su6mitted as part of the Backwater Prevention Device rebate program. [ither ihis form or your own invoice form wilh the following line items can be submiited.This allotivs you to invoice your client according to your existing billing template while allowing city staN to identify how cosls eligible for the Backwater Prevention Device Rebate were accrued. Only labor and materials direcfly related to the installaBon and function of a b e�f(o�hls formn device are eligible for Ciry rebate and there(ore should be incl�ded on the upp Addifiona!costs may Ge added to bo�tom o(fhe foim. � ` _' cI'.C' �' v Business Name:Ny�j.ltzL2�, ' �•"Y�[-'��=SL cense Number. �J�S,��'.1� - rl�L�� '�-�r-11c'�L---�.� 0�.�n3 Business Mailing Address: c��o � City State Zip Phone'.�k��t� •� '._ Email: i �? l�!'�[�1��'i�t]c!_��.b�:�9 Categ� Descri tion Units � �uanti Rate Total Administration Administration/management Hours I.abor CC7V Inspecfion Hours _� __�� _� gVJV Install Hours _. Pipe replacemenl Hours � '� Surface restoration Hours Site cleanup Hours _ Downspouls I drainagc imV� Hours Materials Per Unit Backtvater valve } !/8 �-ti��-a+�� Grinder pump Per Unit �J Side se�ver pipe(up to 8 teet) Feei �� aG�-� _ 5 Imported Backfill Yards _ _—_ Surface Resloration Malerials Lump to soil,grass seed, concrete etc._ sum _ � � — Cover(irrigalion box or lond benring Per Unil � r,over _ ____— Rentals Specify equipment Hour _ __ __. G — — �' ---— — Fces Disposai fees by ilem __ Yards _ ,y�ac1..'.�_�_- ��---- pciivery iees if nol covcrcA 6y labor _—�__ _ _ ______ ___---- -- -- -- ---- --- - � __ - --- -- -- - -$� . Eli ible Total •D � Othcr Costs Cnsts nol assoaaled�vith �WD,and - _ — not eli i6te for rebate delail below ____ -- - - — — �1L ,Fo p [Cthuct� �� q� - — _ — a,�c ok. — — ll.0 i,Nbntl �(�<�/�S Ineligiblc Totai $ . � Total —.-- — - Revised 9/03/20f4