Laserfiche WebLink
BACKWATER PREVENTION PROGRAM <br /> MUCE 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 /> A r License Number: <br /> Business Name05as!�4c� <br /> Business Mailing Address: % t. rkrt 6P, Et �e - ("(-)IqLSL)a <br /> City State Zip <br /> Phone:,,,*.Z-'(:7 4,.Yqb Email: <br /> —da—tegory Description Units Quanti 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 d <br /> Downspouts I drainage imp. Hours <br /> Materials Backwater valve Per Unit lob <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet A"4:44 6M 40T <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> to soil, ass seed, concrete, etc.) sum 13 0 <br /> Cover(irrigation box or load bearing Per Unit <br /> cover) <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards C!� <br /> Delivery fees if not covered by labor <br /> Eligible Total Y C, . ........ $ <br /> Other C Costs-not associated with BWD, and <br /> Gusts <br /> not eligible for rebate(detail below) <br /> 1-J <br /> Ineligible Total 711VLw <br /> Total <br /> Revised 910312014 <br />