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BACKWATER PRE!lENTION QROGRAM <br /> INVOICE CO�T BREAKDOWN <br /> Please use this Invoice Cost Breakdown as a template for invoices submitted as part of the Back�vater <br /> Prevention Device rebat� program. Either this form or your own invoice form witli the following line items can <br /> be submitted. This allows you to invoice your client according to your existing billing template while allowi�g <br /> city stafi to identify how costs Pligib�e for the Backv�ater Prevention Device Rebate were accrueci. <br /> Only labor and materials directly related to the installalion and tunction of a backwater prevention <br /> device are eligibfe for Ciry rebate and therefore should 6e included on the upper half of this form. <br /> Additional costs may be added to bottom of the (orm. <br /> 'S��w�` �� �J��i`1•\ <br /> Business Name;�'1Pr��c-7-� � <. P, License Number: _� �- — <br /> Business Mailing Address: ��c �.Gc(���!'t iE-- F�i'� �-��� �����3 <br /> City State Zip <br /> Phone:�Y��.�G!r� •-;Ylu:� Email:���nawr��an 4,ll�i�_�ann S'�iP�N,-,2�!: C'c�7'1 <br /> Cate o Descrl tlon Units Quanti Rate Total <br /> Administration Administration 1 managemem Hours <br /> Labor CCN Inspection Hours �• <br /> BVJV inslall Hours <br /> Pipe replacement Hours <br /> Surface restoralion Nours <br /> Site cleanup Hours _ <br /> Do�vnspouts 1 d2inage imp. Hours <br /> Materiats Backwat=r valve Pcr Unit ,c�(7 .c5� o� <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet �' �� � ' �� <br /> Imported Backfill Yards _ <br /> SurtaCe Resloretion Materials Lump � � �� <br /> IO 5011,(]f2SS S88d CO�CfOIC BIC.) S11R1 <br /> Cover(irrig.:ticn hnx or load bearing Per Unit � I � � <br /> cover <br /> Rentals Specify equipment Hour _ <br /> ��-�}{Z_ '� <br /> Fees Dis osnl feos by item Yards <br /> Dciive fees if not covered by Iabor <br /> Eli Ible Total a' $ � <br /> other Cosrs Gosts not assuciated���ith BWD,and <br /> not eli ible(or rebale (detail below) <br /> I� c� �u" <br /> .v„y c� ! <br /> � <br /> lu�.cpu <br /> IneligibleTotal � � � <br /> $ <br /> Total <br /> Revised 9/03/2014 <br />