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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 /> city staff to identify how 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 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: 1` <� � ' License Number: =� sX <br /> Business Mailing Address: &tf;G C.E f e Vt JIM- <br /> City State Zip <br /> Phone: 2' -` RCJ -,20�-X Email: . rtrlr,��,� n'*,tn, ,I rind :5, L, nc C—,K an <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours <br /> dW lnstall Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> i <br /> Downspouts/drainage imp- Hours <br /> Materials Backwater valve Per Unit <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet r a - <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 <br /> cover <br /> Rentals Specify equipment Hour l <br /> i <br /> _ I <br /> b <br /> Disposal fees Yards <br /> Fees p Y item l <br /> 1 <br /> 1 <br /> Delivery fees if not covered by labor <br /> Eligible Total $ <br /> Other Costs Costs nat associated with BWD,and <br /> not eligible for rebate detail below <br /> �.0A vt f <br /> Ineligible Total $ <br /> Total $ " <br /> Revised 9/03/2014 <br />