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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 fol#owing 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 /> 3 <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: C9�'1 License Number <br /> Business Mailing Address: t C � �� G <br /> ++2 _�� y, <br /> Phone I Email: <br /> Category Descriptio Units Qua Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours ! <br /> 8WV Install Hours <br /> Pipe replacement Hours <br /> Surface restoration Hours <br /> Site cleanup Hours / <br /> r <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 f &00 <br /> (top soil, grass seed concrete etc. sum <br /> Cover(irrigation box or load bearing Per Unit f <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 ell ibie for rebate detail below <br /> j 12 <br /> lneli able Total F' $ <br /> Total �✓ _.. <br /> 3 t <br /> Revised 9/0312014 <br />