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MB AOCKWATER PREVENTION <br /> 4--Tr 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 r <br /> be submitted. This allows you to invoice your client according to your existing billing template while allowing I <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 /> �-1-`J t--1 <br /> Business Name:_ v ` � 7.��� ' ����' License Number: :- 64 <br /> Business Mailing Address: �Rbde 4� � lit r t W4 f � <br /> City State Zip i <br /> Email: i�1I''J �i, = -_ -t- <br /> Phone: `�j� "'� `};� ,� � lf' r� r �� � <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours <br /> BVW Install Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Materials Backwater valve Per Unit I" <br /> Grinder pump Per Unit <br /> Side sewer pipe (up to 8 feet) Feet �r t< -aq57 <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> to soil, rass seed, concrete, etc. sum iz; <br /> Cover(irrigation box or load bearing Per Unit <br /> cover <br /> Rentals Specify equipment Hour <br /> Htf- <br /> Fees Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> l <br /> Eligible Total <br /> Costs not associated with BWD, and <br /> Other Costs not ell ible for rebate detail below) <br /> Ineligible Total ? . <br /> Total $ <br /> Revised 8103/2014 <br /> I <br />