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E . I <br /> INVOICE <br /> Please use this Invoice Cost Breakdown as a template for <br /> o d as part <br /> the of the <br /> iB line items can <br /> ter <br /> Prevention Device rebate program. Either this form or your <br /> own inva ce frn <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 grad materials directly related to the installation and function of a backwater <br /> er half�phis forma <br /> device are eligible for City rebate and therefore should be included on the upp <br /> Additional costs may be added to bottom of the form. <br /> C- License Number: <br /> Business Name;, <br /> Business Mailing Address:ab1 City State Zip <br /> Phone:;X---� <br /> Cate o Descri tion Units Quanti Rate Total <br /> Administration Administration i management Hours <br /> Hours <br /> Labor CCN Inspection <br /> gWV Install Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours <br /> Downspouts/drainage imp. Hours <br /> Per Unit <br /> Materials Backwatervalve per Unit <br /> Grinder pump i rr <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 l <br /> cover Hour <br /> Rentals Specify equipment A <br /> .CA- <br /> Disposal <br /> Fees fees by item Yards <br /> Delivery flees if not covered by labor <br /> ° $ <br /> Eligible Total + <br /> Other Costs Costs not associated with BWD,and <br /> not eligible for rebate detail below <br /> i <br /> $ <br /> Ineligible Total <br /> Total <br /> Revised 910312014 <br />