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BACKWATER PREVENTION PROGRAM <br /> 0477 INVOICE COST BREAKDOWN <br /> :lease 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 /> city staff to identify how costs eligible for the Backwater Prevention Device Rebate were accrued. <br /> i <br /> Only labor and materials directly related to the installation and function of a backwater prevention <br /> device are eligible for City rebate and therefore should be included on the upper half of this form. <br /> Additional costs may be added to bottom of the form. <br /> Business Name:_� t.47�' License I3umber_ <br /> �I1 x <br /> Business Mailing Address. �f <br /> ca <br /> Phone: ° � / L� , Email: Gti�/� i/� L_ �` 6 77l , <br /> Category Description Units QuaMity Rate Total 7 <br /> Administration Administration 1 management Hours <br /> Labor CCN Inspection Hours -2 <br /> BWV Install Hours <br /> Pipe replacement Hours 0 0 <br /> Surface restoration Hours <br /> i Site cleanup Hours i <br /> Downspouts/drainage imp. Hours <br /> Materials Backwater valve Per Unit y i <br /> i <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil,grass seed, concrete, etc. sum <br /> Cover(irrigation box or load bearing Per Unit 1 <br /> cover <br /> Rentals Specify equipment Hour <br /> ii <br /> J <br /> Fees Disposal fees by item Yards <br /> E <br /> Delivery fees if not covered by labor <br /> Eligible Total $ s <br /> Other Costs Costs not associated with BWD,and <br /> not eligible for rebate detail below <br /> qw <br /> Ineligible Total $ <br /> Total <br /> Revised 9/03/2014 <br />