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BACKWATER PREVENTION PROGRAM <br /> , 4-77- 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 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: 4,4 Plum la 1 n q Li.c License Number: fi-/* Pl y NEN t P 0 <br /> amc . <br /> Business Mailing Address: 86 L( n 5 I-CU'CU✓lPL itVIF Eves cr 9c'2—& j <br /> t City St e Zip <br /> Phone: 4 z S 429-01Z3 Email: p1G-ry1 1 n() L.44. C el__Onitht <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours / 2 p C) <br /> BWV Install Hours / l6- <br /> Pipe replacement Hours / 3 3'0 <br /> Surface restoration Hours / d-"ts <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Materials Backwater valve Per Unit C' 'Z--'Z'D <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet <br /> Imported Backfill Yards (gad) -—S ) <br /> Surface Restoration Materials Lump <br /> (top soil,grass seed,concrete, etc.) sum <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) / 70-0 <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> Eligible Total $--3 Z .n"e . m <br /> Other Costs Costs not associated with BWD, and �,n <br /> not eligible for rebate (detail below) 7'Jy—X -3 a— <br /> (U <br /> Ineligible Total $ J 7 <br /> Total $ <br /> Revised 9/03/2014 <br />