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• <br /> 47.,-- <br /> BACKWATER PREVENTION PROGRAM <br /> INVOICE COST BREAKDOWN =r. <br /> fi <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 /> /� 5Earri LLC" <br /> Business Name:{ / "mi _�.'irr C.. " ' e License Number: r-}6,364:53 <br /> "7 53 <br /> Business Mailing Address: c % - La r lin £)40.--- j:--ti).. °. I.h Q `0 `3 <br /> City State Zip <br /> Phone:, '. O -' - Email: Ja.cr it ` ji, ,.7, "c:-..1r` a .":. _ , C° . <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours t ,C1"7) <br /> BWV install _ Hours I <br /> Pipe replacement Hours <br /> Surface restoration Hours (.(2j/ [a uo I q <br /> a(2) <br /> Site cleanup Hours <br /> Downspouts I drainage imp. Hours <br /> Per Unit t // Oce f 1 j <br /> Materials Backwater valve tai b r <br /> Grinder pump Per Unit .1 <br /> Side sewer pipe(up to 8 feet) Feet 4-I r c,r 3Ci+ W 57 <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil, grass seed, concrete,etc.) sum <br /> Cover(irrigation box or load bearing Per Unit J /,--,Ycover) <br /> Rentals Specify equipment Hour <br /> .' Ac - t '-) - <br /> Fees Disposal fees by item Yards 2 D.7 <br /> Delivery fees if not covered by labor <br /> Eligible Total / 4 !./C9,. . O4-VP $ _43i-k <br /> Other Costs Costs not associated with BWD, and <br /> not eligible for rebate (detail below) <br /> Ci r&AI/v(4c ts- U'1(`t,''.) <br /> Aral.,a ,- , <br /> p, <br /> It-01tLt..wt. a/I <br /> / <br /> Ineligible Total _ $ <br /> Total $`;`f 3i <br /> , <br /> Revised 9/03/204.4 <br />