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BACKWATER PREVENTION PROGRAM <br />INVOICE COST BREAKDOWN <br />Pl�ase use this Invoice Cost Breakdown as a template for invoices submitted as part oi the Backwater <br />Pn;vontion 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 />cih� staff ta identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br />Only /abcr and materials di►ectty rielated to the installatfon and function o� a backwater prevention <br />devlce are eNgible Por City rebate and the�fore shoufd be included on the upper hall of this lo►m. <br />Additional crostc mav be added to boftom o� Me lorm. <br />Business Name: <br />R��cinoss Mailina Address' <br />License Number: .�� ✓ n° ��Pr <br />Revised 9/03/2014 <br />