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I <br /> BA(:KWATER PREVENTION PROGRAM ! <br /> � INVOICE COST �REAKDOWN ' <br /> i <br /> P!ease use this Invoice Cost Broakdown as a templale(or invoices submitted as part of the Backwater � <br /> Prevention Device rebate program. Either this form or your own invoice fomi with the fol�owing line items can f <br /> be submdted.This allows you to invoice your client according to your existing billing lemplate while allowing , <br /> city staH to identiFy how costs eligible for ihe Backwater Prevention Device Reba(e were acciued. � <br /> Onfy labor and materials directly related to the installation and function of a backwater preventron ; <br /> devicP are eligible for City rebate and therefore should be incfuded on tlie upper hal!of thls form. i <br /> Addilionaf cosls may be added(o bot(om of the /orrn. � <br /> . ��'Gc�.'�-i(��''� ,���� f <br /> Business Name:�(��1_�'. � ���' � License Number._�J_J�J'"J-L_- I <br /> 13usiness Mailinp Address: v;�-� ����'=�� r-��p �`�`���`i � <br /> City State 7_ip ' <br /> �y�� �_ y�C�`, EmaiC(1 ��/C'') r �!�iraP,�Nr42°(: CxS,� i <br /> ���Of1B:�0__.'.O�'J_C�iu-'7� �'�-`-'l.L-�.�-1 C�1:�..� � <br /> Categor�_ Descri tion Units Quanti Rato Total j <br /> Hours � <br /> Administration Administiation/management _ <br /> Labor CC7V Inspection Flour.; '? ,S � � i <br /> pWV Install Hours _ ` <br /> Pipe replacement Hours _ ' <br /> Hours � <br /> Sur(ace restoralion _ � + <br /> Silc deanup Hours _ I <br /> Downspoutsldraina�eimp. Hours ' �,�. � --V i <br /> Materials Backv�aler valve Per Unil � �i��yy��Q�-V.�� �5�1-- ! <br /> Grinder pump Per Unil �) � <br /> � Side sewer pipo(up fo 8 feet) Fe�� t��.� � G � ` <br /> Imported Backfill Yards _ _, � <br /> -6 $udace Resloration Maleriols Lump ,� � u � j <br /> lo sod grass sced,eoncrete,etc.) sum �_ ,� __ f <br /> Cover(irrigalion box or load bearing Per Unit �� � <br /> COVCf _ - <br /> Rentals Specify equipment Hour _ <br /> � � <br /> "1._lr_(��-L� -- �fZ� � <br /> , <br /> Fces Disposal fc�as by itr.m Yards --- v��-' . <br /> ---- - - -- - -- _`._. � <br /> Deliv�i tee^ i(not covercd by labor _ ___—__._-- <br /> • y .. <br /> ' -- — --- -- - --- <br /> -- -- - — � <br /> Eli �blerotal - ---- � -- -- -- --��♦-� � <br /> � <br /> othcr Costs �osls not associated with BWD,and � <br /> not eli�ihle for rebate(delail belo�v __ _ —_. ._- + <br /> _ � <br /> -- � <br /> - _ _- -- ' �G.-j'0 _a�. c� cro✓ F`vM^q vf147> i <br /> _ -- � <br /> ----- ----- —��- --��ay__ f <br /> I IneligiblcTotal - - J-' � G /7/4 i <br /> j � <br /> Total - --- - --- --- -- — - - -- - � � � <br /> I <br /> i <br /> Revised 9/03/201� � <br />