Laserfiche WebLink
� <br /> / BACKWATER PREVENTION PROGRAM � <br /> INVOICE COST BREAKDOWN <br /> ; <br /> , <br /> Please use this Invoice Cost Breakdown as a template for invoices submilted 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 submitled. This allows you to invoice your client acwrding to your exisling billing template while allowing <br /> cNy stafl to identify how costs eligible tor the Backwater Prevenlion Device Rebate were accrued. <br /> Only labor and materials directly related to the installation and function of a backwater prevenfion <br /> device are eligf6le for City reba:e and therefore should be incl�ded on the upper half of this form. <br /> Additronal costs may bo added to bottom of the form. <br /> C,.,Lt�'l'`�.�.Ci <br /> �� ���,cJ <br /> Business Name:�(`j�"�� '-SL'.�iL�-��t/,�-r License Number:_('-j�7; <br /> BusinessMailingAddress: o��iG� LGc���l �J� ' C`ity�� Sia� � Zip(,�j i <br /> �P�'. Ct Y11 ' <br /> Phone:,a��,-�,���1 •-.YYI�� Emait:���nm���s�� '��iln�i <'��i��r.: S , <br /> Cate o Description Units Quanti Rate Total • <br /> Adminislration Administration/managernent Houis _ <br /> Hours <br /> Labor CGTV Inspeclion ___ _y _ __ � - --��----- <br /> - - - gWV Ins�ali Hours __ __ <br /> __-� � <br /> Pipe�eplacemenl Hours _ <br /> - Hours � <br /> Sur(ace resloration __—_ <br /> � Site cleanup _ Hours <br /> Dovmspouts/draina�e imp. Hours <br /> Materials Backwater valve Per Unit L't�� � '�Qi � ��_. �. <br /> GriOder pump Per Unit � <br /> Side sewer pipe up to 8 feet) _ Feet _ ��' << F3� � —�2.�_ <br /> Imported Bt�ckfill Ya�ds _____ _ ___ <br /> � - Sudace Resloration Materials� Lump � <br /> (p soi1, rass seed,concrete,etc. sum �� _ _3�-_- • <br /> -�-e- 9-- -- <br /> Cover(irrigation box or laad bearing Pcr Unit '� �_ i <br /> cover ---- --�--- . <br /> --- --�------ Hour <br /> Rentals Specifyequipment ____ ___ _. .— — <br /> ' Yln_714.G_�`�-- ---- ---1-- -�_aZ(� - �=��+ , <br /> -- _ _--- - <br /> - — - - <br /> Fecs Ois nsal(�os h ilem Yards --- -,��� `� <br /> --P---- -Y--' --- --- ` <br /> Dr,livory Iees if not covored by labor _ _ , _ . � . ! <br /> Eli ibleToWl----�� ----- -- - $ -- <br /> Other Costs Cosis nol associated tivilh BWU,and _ <br /> not eli ible for rebale delail below) _..� ---- <br /> Ineligible Total $� , , <br /> Totat - -- -- - - -- -- --- - --- <br /> -- - i <br /> Revised 9/03/201? <br />