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BaGkwater Prevention Device <br />Rebate Program <br />i�cYn+�'f No. ul5/I-voy <br />Invoice Cost Breakdown <br />Please use this Invoice Cost Breakdown as a template for invoices submitted as part oi the Backwater <br />Prevention Device rebate program. Either lhis form or your avn invoice torm with the foilo�ving line items can <br />be submitled. <br />Only labor and materials direct/y related to the installation and funcfion of a backwater prevention <br />device are eligible for City rebate and there(oie should be included on the upper half o( this form. <br />Additional rosts may be added to bottom of the (orm. <br />TMZCanf/acfovS,LI-L %�N}.LiL.PFTMZGCLLSi�j�P� <br />Company Name: <br />P�opery .1 ddre ss <br />Date: ��'`/-/j <br />Category Description Units Quantity Rate Total <br />Administration Administration / management Hours �{ � Z # y-Q p <br />Labor I <br />CCTV tns e��tion Hours � .� d� <br />B�NVlnslall �Hours z _ �63 �'7.(� <br />� � Pipe replacement Hours <br />� Surfacerestoration flours � 300 3DO <br />Site cleanup Houts � I 0 0 <br />Downspouts / drainage irnp. Hours � � <br />Materials <br />Backviater valve _ Per Unil �LDD �ZQO <br />Grinder pun:p Per Unit <br />Side see�er pipe (up te 8 feet) � Feet .� � Q _��__ <br />Imported Backfill Yards � <br />SuAace Restoration Materials Lump I � LO '1 � <br />to soil. yrass seed, concrete, etc. sum <br />Cover (irric�alion box or load bearing Per Unit r <br />cover �S6 �S d <br />Rentals Specify equiprnent <br />CG Ca.�r.�-Sa.��v Hour / �(LO -�lZ� <br />Fces Disposal fees by item _ Yards / ,f � � p _, f�d a _ <br />Delivery fees if nol covered by labor <br />Other __ si':l.e, se.wcr�en..l+ _ l O___'13� <br />Eligible Total 5 .z2 � /c <br />Other Costs Costs not associaled �vith BLVD, and <br />not eligible for rebate (detail belo�s) _ <br />Ineligible Total 5 <br />subtotal 5 22 Q (o <br />Ta[ (9.2%) 5 A/Q $/ <br />_ Totai 5 �y 96, 3 <br />Revised 12/11/2014 <br />