708 HOYT AVE 2016-10-03 - Laserfiche WebLink

b BACKWATER PREVENTION PROGRAM INVOICE COST BREAKDOWN Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Backwater I Prevention Device rebate program. Either this form or your own invoice form with the following line items can a_ be submitted. This allows you to invoice your client according to your existing billing template while allowing i city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. i r Only labor and materials directly related to the installation and function of a backwater prevention device are eligible for City rebate and therefore should be included on the upper half of this form. Additional costs may be added to bottom of the form. 3 Business Name. eoccz1n 6e rl . License Number: Business Mailing Address: �R&-tic Ladirt i�1!� �(�� f i L `� a City State Zip i Phone:,XD6.1,Q b -',��' Email:'=i1«iwriccn,�,#�lild '5A—Eeff CategoDescri tion Units QuantityRate Total Administration Administration/management Hours Labor CCN Inspection Hours BWV Install Hours Pipe replacement Hours Surface restoration Hours Site cleanup Hours t Downspouts/drainage imp. Hours 3 Materials Backwater valve Per Unit Grinder pump Per Unit Side sewer pipe up to 8 feet) Feet 44ilk N 9 67l Imported Backfill Yards Surface Restoration Materials Lump 7 (top soil, grass seed, concrete etc. sum 60I Cover(irrigation box or load bearing Per Unit ! cover Rentals Specify equipment Hour ' VA Fees Disposal fees by item Yards # Delivery fees if not covered by labor Eligible Tota[ Other Costs Costs not associated with BWD, and not eli ible for rebate detail below tjk- 13 le 141? TLS• Ineligible Total Total ? z Revised 9/03/2014 s I