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BACKWATER PREVENTIONPROGRAM <br /> INVOICET 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 Name4.aier-jazL �I�t r:G `iir�LLicense Number: , a <br /> Business Mailing Address: {acs f`�t G'l ft i - ����(` TJ <br /> City State Zip <br /> Phone '_r J. r ,, z Email: ''_ l ) y» <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours <br /> 78—WV install Hours <br /> Pipe replacement Hours <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 E� <br /> i. <br /> Imported Backfill Yards <br /> Surface Restoration Materials Lump <br /> to soil, rass seed, concrete, etc. sum <br /> Cover(irrigation box or load bearing Per Unit <br /> cover `- <br /> Rentals Specify equipment Hour <br /> L <br /> Fees Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> Eli ible Tota[ $ <br /> Other Costs Costs not associated with BWD, and <br /> not eli ible for rebate detail below <br /> CA <br /> I�tm. t <br /> Ineligible Total / <br /> Total <br /> Revised 9/03/2014 <br />