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Backw�ater Prevention Device <br />R�bate Program <br />fnvoice Cost Breakdown <br />Please use this Invoice Cost Breakao��.�n as a template for invcicrs submitted as part of the Backwater <br />Prevention Devir,e rehate program. Fither this form or your o:;n invoice form e�ith the foiloaing line items can <br />be submitted <br />Only labor and materials directly re/ated to the installati�n and funciion of a backwater prevention <br />device are eligible (or Ciry rebate and therefor? should be incfuded on t/te upper half of this form. <br />Addifiona! costs may Ge added to bottom of the torm. <br />Company Namc�f,�_��C��� Date: ��'�2 - �� <br />Property Address:�� _�� �f���_�4�—�,I� �__ _ _ __ <br />/ <br />�Category i Description Units Quantity Rate Total I <br />' Admin(stretion I Administration / management Hours � <br />� Labor 1 ' <br />j_ __ I CCN Inspection Hours i <br />B���.�/ Install Hours � <br />--� Pipe renlacemenl Hours � I <br />Rentals <br />Fces <br />� -- <br />j Other _ _ _ _ <br />Other Costs <br />Surface restoralion <br />Sile cteanup <br />Downspouts / drain <br />Backwater valve __ _ ____ <br />Grinder pump <br />Side sewer pipe (up l0 8 feet) <br />Imported Backfll <br />Surface Restoration tvlaterials <br />lo soil, qrass seed,_ cencrele, elc.) <br />Covr.r (irrigation box or load beanng <br />COVL'� <br />SpeGfy equipment <br />(ees by item <br />Hours <br />Haurs <br />Per Unit <br />Per Unit <br />Fcel _ <br />Yards <br />Lump - -- <br />sum _ <br />Per Unit <br />Hour <br />Yards <br />Delivery tees 1 not cavered by labor � <br />-- - <br />--- -- - —l- - � - - --- <br />--- --- � � ---- - -Ir-- -- � <br />f Eligibie Total 5 <br />Costs nol associaled vrith dWD, 2nd , <br />nol eligible'or r�bale (detail belo.v� _ _ _ _ .__ <br />-- - - - --r <br />I j Ineligible Total S <br />i Subtotal $ <br />— ------- I I-- <br />----- <br />--- <br />7ax (9.2%) 5 { yV; <br />- - -- -- <br />I I Tolal I S% � <br />Revised 12/11/2014 <br />