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I <br /> BACKWATER PREVENTION PROGRAM <br /> 4M77 INVOICE T BREAKDOWN <br /> g <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 /> : <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: /-J-H' 1 = �f License Number: <br /> Business Mailing Address: L <br /> q C State Zip <br /> Phone: }" /' Email:... lob t 3eav <br /> `; <br /> Category Description Units Quantity' Rate Total <br /> Administration Administration!management Hours <br /> Labor CCTV Inspection Hours <br /> BWV Install Hours i ' <br /> Pipe replacement Hours )Po <br /> Surface restoration Hours <br /> Site cleanup Hours <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 ' <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> (top soil,gEass seed, concrete,etc. sum , <br /> Cover(irrigation box or load bearing Per Unit <br /> cover <br /> Rentals Specify equipment Hour <br /> Fees Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> Eligible Total $ <br /> Other Costs Costs not associated with BWD, and <br /> not eligible for rebate detail below <br /> Ineli ibie Total ' $ <br /> Total <br /> b <br /> Revised 9/03/2014 <br />