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Backwater Prevention Device <br /> � ReC�ate Program <br /> Invoice Cost Breakdown <br /> Please use this Invoice Cost Breakdo�vn as a template for invoices submitted as paR oF ihe Backwaler <br /> Prevention Device rebate program. Either this form or your own invoice form with the follo�ving line items can <br /> be submitled. <br /> Only labor and materials directly related to the insta!!ation and function of a backwater prevention <br /> device are eligible for City rebate and therefore sf�ould be included on the upper half of this fonn. <br /> Additional costs may be added to bottom of the lorm. <br /> CompanylVame:DA��N/��'- t�u"������ ' ��"`�ri���_ Date: � �y��� <br /> —�� <br /> PropertyAddress: ��lCr/fG� !t�G���C���'� �• <br /> Categoty Description Units Quantity Rate Total <br /> Administration Administrationlmanagement Hours 3lvS`X-� <br /> Labor <br /> CCTV Inspection Hours /�.�'� <br /> BWV Inslall Hours yc/5. rw <br /> Piperoptac=menl Hours 2v0 `'�� <br /> Surface rer' ��atnn Hours 3(vo °C <br /> - Sitecleanup — - Hours -. -- _. -- 3�-u._ <br /> Do�vnspouts I drainage imp. Hours _ <br /> Materials <br /> Backa�3!dr valve Per Unit ? J <br /> Grindar pump Por Unit <br /> Side sewer pipe (up to 8 feet) Feet ��� o0 <br /> Imported Rackfil! Yards <br /> � Surface Resloration ivialerials Lump <br /> lop soil,grass seed, concrete, etc. sum <br /> Cover(irrigation box or load bearing Per Unit <br /> cover zj`� <br /> Rentals Specityequipment <br /> Hour <br /> Sf(z!�'/A � .>�oZ. OU <br /> Fees Dis osal fees�y ilem Yards <br /> Delivery fees if nol covered by labor <br /> Othcr fCi��n�/� p� <br /> Eligiblc Total 5 $S/-� <br /> Olher Costs Costs not associaled wilh BIND,and ti 1 <br /> not eli Ible for rebale delail belov+ OIL k� jo �a^1''z�-�Fc✓ + ""�` w <br /> . V N �� :-�M �,,•i <br /> Ineligible Total $ SG,4' :i�> }��r,�u� <br /> Subtotal $ 2 7�`�.�§' ��,-:va�� <br /> Tax(9.2°/a) $ '�/D. �Z S-��q�is- <br /> --- Total 5 2 5�'�• `-' <br /> Revised 12/19/20i�7 /��/���/�� �f . • <br /> .� �r r��;/���I • � !/• <br /> - ."�'�'//��/��r�elP �,Gf�� <br />