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i <br /> BACKWATER PREVENTION PROGRAM <br /> 4-177 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 /> 3 <br /> 9 <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. 6 <br /> Business Name:VT)er -,,Z10 License Number:v. <br /> Business Mailing Address: Laden OU ��'l��f�`' f 1 rJ Q&`-.dna <br /> City State Zip <br /> Email:(!i am- ircyIC-5, -i r ld 5ije, -4-a -, <br /> Category Description Units Quantity Rate Total <br /> Administration Administration!management Hours <br /> Labor CCTV Inspection Hours <br /> BWV Install Hours <br /> Pipe repladement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Materials Backwater valve Per Unit <br /> Grinder pump Per Unit 1 <br /> Side sewer pipe(up to 8 feet) Feet ' 67 <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> top soil, grass seed, concrete, etc. sum " C� <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) i <br /> Rentals Specify equipmen Hour <br /> r <br /> Fees Disposal fees by item Yards i <br /> a <br /> fi <br /> Delivery fees if not covered by labor <br /> Eligible Total <br /> Other Costs Costs not associated with BWD, and I <br /> not eligible for rebate detail below <br /> ; <br /> 1 <br /> p3 <br /> k <br /> Ineligible Total $ <br /> Tota! <br /> Revised 9/03/2014 <br />