2810 22ND ST 2022-05-18 - Laserfiche WebLink

BACKWATER PREVENTION PROGRAM 4*rr INVOICE COST BREAKDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater Prevention Device rebate program. Either this form or your -n invoice form with the following line items can be submitted. This allows you to invoice your client according, dour existing billing template while allowing city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. Only labor and materials directly related to the installation and function of a bacater It orprev prevention device are eligible for City rebate and therefore should be included on the upper Additional costs may be added to bottom of the form. Business Name: f -C[ � ��=SLicen<_e Number: Business Mailing Address: State Zip Phone:,9 f ,.�)qb Email:0,;(41c—,,)()m; ric znS2,n4;C—rfdd S;ide8a,r2° (2C 2 9 Cate o Description Units Quanti Rate Total Administration Administration / management Hours Labor CCTV Inspection Hours gWV Install Hours Pipe replacement Hours Surface restoration Hours Site cleanup Hours Downspouts / drainage imp. Hours ',G Materials Backwater valve Per Unit —Unit Grinder pump For Side sewer pipe (up to 8 Feet Feet I / q Imported Backfiil Yards Surface Restoration Materials Lump D (topsoil grass seed, cc^rrete, etc. sum Cover (irrigation box or load bey ring Per Unit cover Rentals Specify equipment Hour Fees Disposal fees by item Yards Delive tees if not covered by labor Eli ibleTotal Costs not associated with BWD, and Othor Costs not eligible for rebate detail below Ineligible Total $ 7 Total _ _f, - Revised 910312014