Laserfiche WebLink
�^' 'ii� ,� ,�� � i; ,i � �� ;�` �it ! ;.� ��►' l. <br />� ra <br />.� & � � � ` _ � :' ' ' r'' i � r <br />f'fea�e use this i�voEce Cost Breakdown as a temp[ate far invoices submitted as part of the Backwater <br />Prevention Device rebate program. Eiti�er this form or your own invaice farm with the toiiowing line items can <br />be submitted. This alfows you to invoice yt�ur clienf according to yaur existing bi(iing ternplate whife aClawing <br />city staff to icientify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only labor and materials directly related fo the installation and funciion vf a backwater preven#ion <br />device are eligible for City rebate and fher�fore shnuld 6e rncludecl on fhs upperhalf of thls form. <br />Additional costs may be added fo 6Qitom of the form. <br />� ���,�,�,�, �,,�'..�.,.-� *-, � .,�" �' <br />Business Name:����:�-i_i r��,�� ;�=��{3�;�, �;�- ���nf � License Number: , ( �e�;�a��`�"��� <br />Business Mailing Address: ��::� 0..�:�t"�G"� b'�+�- .�.-:.-,�%���t"'�7 ��'1�� `�' ��t !�.� _ <br />City State Zip <br />Fho�e: :�'; :� -`.���t� �����`� �. Email:�� a ,��'���� r� -,� ;��.�,'�i''� � '�,�.� -�r��,�;-r 2'��� :�'�� <br />Cate o Descri tion � Units Quantit Rafie Total <br />�:dministration Administration / management Hours <br />Labor CCTV fnspection Hours '°` <br />8W4/ instal! Nours <br />Pipe replacement Hours <br />Surface restoration Haurs � � , � <br />Site cieanup Hours <br />downspau#s I drainage imp_ Hours <br />Materials Backwater valve Per lJnit :-q- � . „- ,, , � <br />Grinder pump Per Uni# <br />Side sewer pipe (up to 8 faet) �eet �r �_' �. , t +."°. <br />Imported Backflll Yards <br />Surface Restoration Materials Lump <br />to soil, rass seed, concrete, efic. sum '� � ��'� <br />Cover (irrigafion box or load bearing Per Unit <br />cover � �--� � �°` <br />Rentals Specify equipment Hour <br />����- �:°' <br />Fees Dispasal fees by iiem Yards � '""� <br />��W <br />Delivery fees if nat covered by labar <br />Eligibie Tatat .��---- r 4 �.. C� _ $ : < � <br />Qther Costs Costs not assoc�ated with BUtlQ, and <br />naf eli ible for rebate d�tai! beCow <br />i� r � <br />�� <br />i�� e� <br />ineligibie T'otal $ �'1'��1���° <br />Total � � + <br />Revised 9l(?3/2D14 <br />