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BACKWATER PREVENTION <br /> 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 /> 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 /> Business Name: -j . P. License Number. <br /> Business Mailing Address: LL z di n 6P, EtPmth' ipt�-� <br /> City State Zip <br /> Phone:' �, Gt� <br /> Category Description Units Quantity Rate Total <br /> Administration Administration t management Hours <br /> Labor CCTV Inspection Hours <br /> BWV 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 &6ushilk '-0 E42 <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet t _► <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil,grass seed, concrete,etc. sum A 30 <br /> Cover(irrigation box or load bearing Per Unit , t <br /> _ cover <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> Eligible Total <br /> Other Costs Costs not associated with BWD, and <br /> not ell ible for rebate detail below pp <br /> i��Wa s <br /> Ineligible Total <br /> Total <br /> Revised 9/03/2014 <br />