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OGRAM I <br /> BACKWATER RREVENTION PR ; <br /> INVOICE CQST BREAKDOWN � <br /> Please use this Invoice Cosi �reakdown as a template for invoices submilled as parl of the Backwater <br /> Prevention Device rebate program. Eilher this form or your avn invoice form with the tollowing line items can ! <br /> be submitted. This allows you to invoice your client according to your er.isling billing template while allov✓ing ' <br /> cily staN lo identify hc•,v cosis eligible for the 8ackwater Prevention Device Rebate v+ere accrued. j <br /> Onfy labor and materials drrectly related to the installation and(unctron of a backwater prevention � <br /> device are eligi6le for City rebate and therefore shouid be included on the upper half of this forrri. i <br /> Addifiorra!costs ma be addIed to bottom clfhe form. <br /> 8usiness Name: �y��`�'`������ �J����License Number: �C(S� 8'�1� 5 � <br /> � 7/��1,� SJ,J. , � �F�� � i <br /> � w,c�l,5 1� . �f <br /> Business Mailing Address:�(' �v ' 1 i <br /> / ity Stale Zip / ; <br /> Pltone:���� �"'f7S' ������ Email: _u Z: - �+; Ccw S ot,k�r ���1�2�1, �F'�[� � <br /> � <br /> Category Descr�tion _ _ Unils Quantit Rate _ Total _ � <br /> Administration Adminisiration/management _ Hours _ ___ ___ __ ___ + <br /> Labor CCTV Inspec�ion Hours � _ � <br /> BWV Install Hours Q p�Y1 � <br /> Pipe replacement Hours 1 �B�� '_ _ %� ; <br /> Sudace restoration Hours _ ' <br /> Hdurs { <br /> 5iiecleanup — - - ---- i <br /> Do�vnspouts/drainage imp. Hours _ i <br /> Materials Backwatcr valve Per Unil �, .C�'J CU.C�� � <br /> Grinder pump Per Unit ' <br /> Side sewer pipe(up to 8(eel) Feet _ _�, � <br /> Imported B:.ckfill Yards _ __ ' <br /> � Sur`ace Resto�ation h4aterials �-�mP ' <br /> (top.soil,,gcass�,_Sec.L.concrete,eta� sum ____ ` <br /> Cove�(irrigalion boz r luad bearing Per Unit I �- � <br /> covcr) � ----- — ��-- �C'� - i <br /> Renlals Speci(y eauipmenl I lour � <br /> - -- - 7,��C <br /> � <br /> ---- - -- - -_ <br /> -- -- -- <br /> --- -_ _ <br /> Fees Dis asal fees b item ` O U •U � <br /> v � � <br /> -- <br /> --P— -�-_ _-- . Yards - �y li_ � <br /> _� - -- - ; <br /> - ---- <br /> — -- -- �� a oo.co <br /> Delivery fees if not covered by iabor _.__ _ _ `.�a�"/_c___ - _ j <br /> - --— — _ _-r 0 .G D <br /> E�0 ible7otal -- --- — - - `� V •� i <br /> Othcr Costs Costs nol assor.iated�vi1h EiWD, and � <br /> nol eli,yible for rebale{detoil 6elow_ __ ___ _ -- � <br /> --- — - — - - ; <br /> --�- - - __ -- �-`_- ` - i <br /> _-- - ' i <br /> --_ -- - _ ---- --- - -�'- i <br /> _ _ - - I <br /> Ineligible 7otal � � <br /> �Total ---__ S __ <br /> --- ---- � <br /> i <br /> i <br /> � <br /> Revised 9/03/2014 � <br /> � <br />