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1 <br /> 4ETT ' BACKWATER PREVENTION PROGRAM <br /> INVOICE COST BREAKDOWN <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 /> citystaff to identifyhow 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 It of his fnrmn <br /> device are eligible for City rebate and therefore should be included on the upper <br /> Additional costs may be added to bottom of the form. <br /> 5.6.0'�L <br /> Business Name:4yfl (fp 1,-) S-fp iC..4-' itiE'- License Number: t 16�j64kg <br /> Business Mailing Address: 4, Let dirt 6 4-. / v -91 1,6)14 Q `P(-)`' <br /> City State Zip <br /> Phone: 0',Q/0 ..-• s:4 Email:(_1rrt1"tr ei 4:4 1d 5;dei ,,f,rrr c <br /> orn <br /> Category Description Units Quantity Rate Total <br /> Administration Administration I management Hours <br /> Labor CCTV Inspection Hours 1. '',\-0 3LSZ <br /> BWV Install Hours <br /> Pipe replacement Hours <br /> 3 Surface restoration Hours f JD ___Ac -W <br /> Site cleanup Hours <br /> Downspouts i drainage imp. Hours <br /> Materials Backwater valve Per Unit till 1,06-+ Li S c<s <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet •tl,fyot/ .g11cls' (5 7 <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil,grass seed, concrete, etc.) sum t JD 3D <br /> Cover(irrigation box or load bearing Per Unit 1.4.cover) <br /> Rentals Specify equipment jj ;�,e Hour <br /> Fees Disposal fees by item Yards _..,._---"'''--9 ° " <br /> Delivery fees if not covered by labor t t <br /> Eligible Total .1-- E Ci - 4' $ (9. t fS rl°) <br /> Costs not associated with BWD, and <br /> Other Costs <br /> not eligible for rebate(detail below) <br /> 04. f-o p C teat c~t a t, CAM l <br /> -ria <br /> tte jtS rnrf <br /> Ineligible Total $ <br /> Total <br /> Revised 9/03/2014 <br />