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BACKWATER PREVENTION PROGRAM <br /> . '‘ '' ';0"-A--. <br /> 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. Either this form or your own invoice form with the following one 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/ffior 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 /> . MI-P/ <br /> Business Name- (-men b.f LL.0 License Number. --P1u} bi leo <br /> Business Mailing Address: 3?t i"1 or& R.. 1114F Eve4-ecr 9 '8 <br /> Phone: G S 4 ' LAC 2 3 Email: herri I n C.I Ct7 c7niet i t <br /> Category Description Units ^Quantity Rate Total <br /> Administration Administration I management Hours <br /> Labor CCTV Inspection Hours / < <br /> BWV Install - Hours / f 2,.5 <br /> Pipe replacement Hours <br /> Surface restoration Hours _ ,2.5"0 <br /> Site cleanup Hours it % -1::::' <br /> Downspouts I drainage imp. Hours <br /> Materials Backwater valve Per Unit f '2-- C <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet <br /> Imported Badfill Yards <br /> `5 Surface Restoration Materials Lump / L� <br /> d i (top soil,grass seed,concrete,etc.) sum /7 <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards <br /> "C_._ ( `?eta <br /> s Delivery fees if not covered by labor _ <br /> Eligible Total <br /> Other,Costs Costs not associated with BWD,and <br /> not eligible for rebate Scletail below) w <br /> acki <br /> 7794 i ell) , . .............-- <br /> Ineligible Total - - - $ (` <br /> Total $ . <br /> Revised 9/03/2014 <br />