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Contractor SecNon: <br /> t-flfx'1`i(11Y1-�-�,,'�i� Li1'L�Si.J�--CNs1tCt�C. ' g <br /> Vendor Name/Business Neme/UBI Number <br /> ��T��S AO� h� <br /> Stete af Washington Conhaclw License Number. <br /> ar�tYo L�r-l� �,�p , Eix�lf t�f�q�3 <br /> ' Vendor MailMg Address �ryy 3�� 7�p <br /> ���s�. e.�:��;�,�4,����,� .� <br /> Phone EmeH <br /> I,ths Venclor,egies lo receive IFre Badkwater PrevenUon Device robate chedt diredly fa the <br /> InstaAalbn at the abwe referenced prbperty address.By apreeing to rece(ve the rebete ctbck <br /> . dinctly, 1 apree lo tM followirp: � <br /> 1. The Backwetsr PnvenNon rebale emount wiN be deductad hom ihe fmal invoke <br /> givan to the properly ownat fo the installNion al the property eddreae releronced above,If <br /> � the toW cosf of fhe Meta1latlon M pmster than Ms rebate. <br /> 2. I,Ihe Vendor,em a Waehfrpton 3tete Ikensed conlractor. I <br /> 3. The City of EvereH wiN sand a Faderai Form 1099 MISC to me,tlis VerMor,(or Backwater ( <br /> PreveMlon Device robate peymente toteNng more Ihen E600 pw cebnder yaer,and will <br /> report the same payments b the Interttal Revenue Service. I <br /> I <br /> I eccopt the paymont o!Ihe Beckwaler Praventbn Oevlce robate from tM City of Everott pendinp � <br /> approvd of Ihe compbled Batkwater Proventlon Device rabate packape by fhe Ciry of Everelt ! <br /> � <br /> 1 <br /> � �.�o. • � � <br /> Signature ot ConVecla Date � <br /> . I <br /> � <br /> � <br /> ( <br />