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BACKWAI�ER PREi/EfVTION PROGRAM <br /> INVOiCE COST BREAKDOWN <br /> Please use tnis Invoice Cost Breakdown as a template (or invoices submitted as pari of lhe Backwater I <br /> � Prevention Device rebale program. Either this form or your own invoice form with the following line items can ' <br /> be s�bmitted. This allows you to invoice your client according to your existing billing lemplate while allowing + <br /> city staH to identify how cosis eligible for the BacY.water Prevention Davico Rebate were accrued. <br /> Onty labor and materials directly related to the insta/lation and function of a bae k��f o f hls tormn <br /> device a�e eligible for City rebate and iherefore should be included on the upp <br /> Additional cnsts may bo added to bottom of the form! �� �� <br /> c:F'Cw � �' ,� /L <br /> , c, P, License Number:_���1� <br /> BusinessName:�T� �1..!�—�-��--��� <br /> oi� i.u.r�<« ��- . Frlc.'�_--�8 �F.�s�'3__ � <br /> Business Mailing Address: _ �ity Staie Zip <br /> �• Emaii:_(� ,�'��i.Q�Ctsc�-��' � �L1l1--�i����a��2"(: C�"�"/ I. <br /> Phone:��', �� ��2�� 'L."'�„'" -�--�` <br /> Description Units Quanti Rate Total � <br /> Catc o Hours — <br /> Adminislration Administralion/mana�emeni �lours I1 �� -S— <br /> Labor ___ CG7V Inspeclion --- Hours T <br /> BNNIns, tall______ I <br /> Pipe replacement Hours __ _ _ - — j <br /> Surfaco restoration __ Hours _ V <br /> — $ilo cleanup _ Hours P� <br /> pownspouts/drainaye imp. Hours - � <br /> — Per Unit ��1�� � <br /> Materials �ar.kwatervalve . <br /> — Grinder pump Per Unit <br /> Side sewer pipe(up l0 8 feet) _ Feet � �� G`Z _�—�� I <br /> Imported Backfill Yards —---- <br /> --- Surfacc Restoralion Matcrials Lump .? 3� <br /> _{top soil�rass seed,concrete etc. sum �_—� <br /> Cover(IrrigaUon box or load be�ring Per Unit �� �� <br /> _ cover --- Hour -� <br /> Rentals __ Specifyequipment_ _ ? — n-���. <br /> __;��Cr.�R—�---- _ v{6 <br /> ----- Dis osal fees b ilem Yards __ ---_..- --- <br /> Pecs Y----—�—— -- -- <br /> -------�—— — —__-— <br /> —� Delivery fees i(nol coverecl bY labor ___—.--- - --- <br /> - --- --- .—--- ---�'. -- $- <br /> Eli ihleTotal <br /> Cnsts nol associaled with BWD, and <br /> Othcr Costs nol eli ible tor rebate{delail belo�vL __ ------- ---�� — <br /> --- — ��� �p r ;rN._iV-a✓ Mr <br /> _�— -- — — — vL L7i — <br /> --- ° �"`' --- <br /> --- — -- — -tj� �c�^..�f'�' — <br /> -- � -� i�� ,r <br /> Ineligible Total � <br /> Total __-- -----— -- - <br /> — ----— -- - <br /> Revised�/03/2014 <br />