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,Il <br /> 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 /> i <br /> I <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 /> n <br /> -} 0- r <br /> Business Name: , ��p1�t �� }�1 License Number: } � �I/ 4 <br /> � l <br /> Business Mailing Address: j rs ' 6L' r�. `Ever- L,. <br /> ,LI -t <br /> � <br /> City State Zip <br /> Phone: 42_S---/-19? arrEmail: �l vp-YI L[1104,L C (9 n( -) (`?7,v►RA. <br /> i <br /> Category Description Units Quantity Rate Total F) <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours i c <br /> BWV Install Hours l i2 0 <br /> Pipe replacement Hours i 51 <br /> Surface restoration Hours ( 5 d 0 $: <br /> Site cleanup Hours i S <br /> Downspouts/drainage imp. Hours <br /> f <br /> Materials Backwater valve Per Unit / .SC <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet <br /> i <br /> Imported Backfill Yards ( 5-0 <br /> Surface Restoration Materials Lump ,�� <br /> U <br /> (top soil, grass seed, concrete, etc.) sum i <br /> Cover(irrigation box or load bearing Per Unit 9 i <br /> 1 <br /> cover) 1 <br /> Rentals Specify equipment Hour I <br /> 0-A'"i- cf_i22i'vt C'`•� <br /> Fees Disposal fees by item Yards 1 / 9$ <br /> pow hn i l Y , C <br /> -cc— <br /> r"`•'l'1 Delivery fees if not covered by labor <br /> i <br /> Eligible Total .�.�.o.r3 $ CIC' I <br /> Other Costs Costs not associated with BWD, and <br /> not eligible for rebate (detail below) I <br /> I <br /> yE <br /> F <br /> i <br /> i (� <br /> $ I moi. <br /> Ineligible Total E <br /> Total �S1—\-) $ 1 i l q , <br /> i <br /> I <br /> Revised 9/03/2014 1 <br />