Laserfiche WebLink
BACKWA�'ER PREVENTION PROGRAM <br /> INVOICE COST BREAKDOWN <br /> Please use this invoice Cost Breakdown as a templale for invoices submitted as part of the Backwater <br /> Prevention Device rebale program. Eilher this form or your own invoice form with the folloH ing line items can <br /> be submitted. This allows you to invoice your client eccording to your exisling billing �emplate�vhile allowing <br /> r.ity staft to identify how costs eligible for the Backwater Prevention Device Rebafe�vere accrued. ' <br /> Only labor and materials directfy related fo the installation and funcfion of a backwater prevenUon I <br /> device are eligible for Ciry rebate and therefore should be included on the upper half of this form. <br /> Additional cosfs may be added tn bottom o(the(orm. <br /> � � �� � /,� <br /> Business Name:, • �ri i� 1� � `�.d�`�ir�P.SLic nse fdumber. ��;�j,���____ ` <br /> BusinessMailingAddress: o�fcY.�p �Lc��YI tJl�-�• — �'rP-� �1L� ��`at�3 ; <br /> City State Zip i <br /> Phone:�:(,o,.�/Q��Si� EmaiL•(�i��ranwrrc��./N-�� iz^� S��N��'-��°r CcSYI'I <br /> � <br /> Cate o �escri tion Units Quanti Rate ToYa) '� <br /> Administration Administ2tion!management Nours _ _ ____ � <br /> Lahor CCTV Inspection Hours _ _ <br /> BVJV Install � Hours � <br /> Pipe replacement HOufS _ f <br /> Surface restoration Hours � <br /> Site cleanup Hours i <br /> Dovmspouls/drainage imp. Hours _ <br /> Matertais Dackwater valve Per Unif �5 - _�� __ <br /> Grinder pump Per Umt <br /> Side sewer pipe(up to 8 feet) Feet ` << (,� ��R �7—_ � <br /> Imported Backfill Yards _ <br /> Surface Restoration Materials Lump � <br /> to soil, rass seed, concrete etc. sum � � 3�_— � <br /> Cover(irrigalion box or load bearing Per Unil I � <br /> cover) �----—1—�-- <br /> Rentais Specify equipment Hour _ _ , <br /> ---- ---��� — =�-- -- <br /> Fees __ Disposal fees by ilem Yards �._�_ <br /> Oelivery fees if not covered by labor .— <br /> Eli ible Total a � <br /> Othor Costs Costs nol associated wilh BW�, and <br /> not eligible fur rebate(detail below) _ <br /> ---- �C ili �L� L'� ! <br /> ---- _— � .b.��_ � - � <br /> Ai�� �w � <br /> Il I�w .'({l �1_� . <br /> Ineligible Total � <br /> Total __ ____ � ` <br /> � <br /> 'i <br /> Revised 9/03/2014 I <br />