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Business Mailing Address: <br />Phone: L'L - 4 <br />Category <br />Description <br />Units <br />OUantit <br />Rate <br />Total <br />Administration <br />Administration / management <br />Hours <br />Labor <br />CCTV inspection <br />Hours <br />BWV install <br />Hours <br />Pipe replacement <br />Hours <br />Surface restoration <br />Hours <br />( <br />0 O <br />Site cleanup <br />Hours <br />Downspouts / drainage imp. <br />Hours <br />Materials <br />Backwater valve <br />Per Unit <br />Grinder pump <br />Per Unit <br />Side sewer pipe (up to 6 feet) <br />Feel <br />Imported Backfill <br />Yards <br />Surface Restoration Materials <br />(top soil, grass seed, concrete, etc. <br />Lump <br />sum <br />CP <br />Cover (irrigation box or load bearing <br />cover <br />Per Unit <br />/ <br />Rentals <br />Specify equipment <br />Hour <br />Fees <br />Disposal fees by item <br />Yards <br />Delivery fees if not covered by labor <br />Eligible Total <br />Other Costs <br />Costs not associated with BWD, and <br />not eligible for rebate detail below <br />Ineligible Total <br />$ <br />Total <br />Revised 910312014 <br />BACKWATER PREVENTION PROGRAM <br />4w,rr INVOICE COST BREAKDOWN <br />Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater <br />Prevention Device rebate program. Eilher this form or your own invoice form with the following line items can <br />be submitted. This allows you to invoice your client according to your existing billing template while allowing <br />city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only labor and materials directly related to the installation and function of a backwater prevention <br />device are eligible for City rebate and therefore should be included on the upper half of this form. <br />Additional costs may be added to bottom of the form. <br />Business Name: <br />LWI <br />