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B/�CKWATER PREVEINTIQN F'ROGRANI <br /> II�VOICE COS� �REAKnOWN <br /> Please use Qiis Invoice Gost Preakdown as a template for invoir,es submitled as paR oi the Backv�ater <br /> Prevention Device rebate program. Either this form or your own invoice form with the fcllowing line items can <br /> be submitted. This allows you to invo�ce your client according to your existing billing templat�while allr�wing i <br /> city staK b identify how costs eligible for the Backwater Preventwn Device Rebaie were accrued. i <br /> Only labor and materials directly ielafed to the insta!lation cind Iunction of a backwater preventfon <br /> device are eligibfe for City rebafe and therefore should be includrad on the upper half af this form. <br /> Addifional costs may be added to bottom of fhe form. <br /> Business Name: _ '��'�L�J.� L— License Number.__�_�I✓ �� PQ <br /> Business Mailing Address: _ // /U/�]�zcY�t.I11�L _��`7` j�- 9�-0-� __ <br /> C'ly State ��� Zip <br /> Phane:_�Z�=� �7 — �/Z3__ Email:_ f97'� vvr � �'�ol ({Gr��`/[ `c"t1��1L��'� ' <br /> — �T— <br /> Calegor Descri tion Units Quantil Rate Totai <br /> Administralion Administretion/management Hours _ I <br /> Labor CCTV Inspection Hours 1 7 <br /> BWV Install Hours � �2�'V <br /> Pipe replacement Hours �(� <br /> Surface resloration Hours <br /> Site cieanup Hours U <br /> Dovmspouls/drainage imp. Hours <br /> Materials Backwater valve Per Unit I Z S <br /> Grinder pump Per Unit � <br /> Side sewer pipe(up to 8 feet) Feet <br /> Irnported Backfill Yards <br /> Surface Restoration Rlalerials Lump <br /> to soil, grass seed, concrete,etc. sum � � b � <br /> Cover(irrigation box or load bearing Per Unit <br /> cover <br /> Rentals Specify equipment Hour <br /> Fees Di osal fees by Ilem Yards <br /> / `�- O <br /> elive��fees i(not covered by labor _���� <br /> Eli iblc Total 5 <br /> Other Costs �%osts nol associated with BWD,and <br /> not eligible for rebalc (tletail below _ <br /> InaligibleTotal ' S <br /> Total _ � ��� $ � <br /> � <br /> ���� . <br /> Revised 9/03/201R <br /> I <br />