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elP <br /> BACKWATER PREVENTION PROGRAM <br /> •404111 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 /> 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 /> p � <br /> Business Name: 4 —,2f°in b e LI--C License Number: lu+p�l� IA te°' <br /> Business Mailing Address: �� (� OS1746i-V'iz-f4't. 1firbP [� - T <br /> 2 <br /> I C)'ty r State Zip <br /> Phone; � `-t 1' Email: /VI-Pt''f'vi l��(kl- Cc- ci—tl 6, ay,rat1 <br /> Category Description Units Quantity Rate Total <br /> Administration Administration/management Hours <br /> Labor CCTV Inspection Hours I "?,c_v <br /> BWV Install Hours r /2S- <br /> Pipe replacement Hours <br /> Surface restoration Hours 1 2- <br /> Site cleanup Hours ( Z c <br /> Downspouts i drainage imp. Hours , <br /> Materials Backwater valve Per Unit 1 S-X.:5 <br /> Grinder pump Per Unit <br /> Side sewer pipe(up to 8 feet) Feet <br /> Imported Backfill Yards t 3 5 0 <br /> Surface Restoration Materials Lump <br /> (top soil, grass seed, concrete, etc.) sum <br /> Cover(irrigation box or load bearing Per Unit l f <br /> cover) I "l <br /> Rentals Specify equipment Hour <br /> )2,04...A./.-r-- i 3 v <br /> Fees -Disposal fees by item Yards <br /> Delivery fees if not covered by labor <br /> _ <br /> Eli•:ible Total ..__.__ .. ' <br /> �� <br /> Other Costs Costs not associated with BWD, and <br /> not eligible for rebate(detail below) , <br /> ► <br /> Ineligible Total $ 1---52--- <br /> Total $ � .'- <br /> Revised 9/03/2014 <br />