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T <br /> Contractor Section: <br /> � -- -- ---------- - � <br /> A+ Sewcr Technologies I <br /> � Vendor Name � Business Name I UBI Number <br /> 603089164 _____ _,_ <br /> State of Washinglon Contractor License Number <br /> 900 Merfdian Ave E STE 19•193 Mliton WA 98354 � <br /> ------ � <br /> Vendor Mading Address City Stale ZiP <br /> � (BAR) 213•7fi56 infn@sewertcchs.com I <br /> ' Phone Emad ; <br /> � , <br /> , <br /> �-- - ------- -- ---- ----- --- - - - ----' <br /> I, the Vando�, agree to receive Ihe Backwalar Provention Device rebate check direclly for Ihe <br /> installation at the above referenced propeAy address. By agrocing lo receive the rebete check <br /> directly, I agrcc to the followin9� <br /> t 1he dackwater Prevention Dovico robate smount�•rill be deducted irom Ihe final Invo�ce <br /> given to lhe property owncr for tho instaltation at the property address referenced above, if <br /> the total cnst of the installation is greater Ihan the rebate. <br /> 2 I, the Vendor, am a Washington State licensed contrector I <br /> 3 The City of Fvereft viilt send a feCeral Form 1099 MISC to me, thc Vendor, for E3ackwater <br /> Prevenlion Device rehate payments toW��ng more inan 3640 per calendar year, enJ will � <br /> report the seme peyments to the Intxrnal Rnvenue Serv¢e <br /> �__ _- -- --- --_ .. . -� --�---- _ I <br /> I atcepl Ihe paymenl of Ihe Bxckwater Prevent�nn Davice rebate from the Ciry ol Everett pendmy <br /> approval of the completed Backwater arovanuon Dev�r.o rebate package by the Gry of Everetl <br /> I �. " "_ � / �.y� - -- �_`-� --- <br /> i Signature of Con ractor Date <br /> � _1 <br />