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Gontractor Section: ' <br /> � -- -- ---- - ----- --- - -. - ---- <br /> I <br /> S'�CICI L'� SLC.�L��-5 ItiL. �' � � 15 - 3U j _ <br /> Vendor Name I Business Name/UBI Number �. <br /> Si �' � csS ���z� .J � ; <br /> ; — _-_ _--- ----- -- _ _ _ _ <br /> Stale of Washington Contractor License Numher <br /> I <br /> 2��51 � L�rl�SiiJe. j�4 /2_ C'iii��.1a�� /S� ��ii_�%�2�?- <br /> --- --._.- - _ ..----- — <br /> Vendor Mailing Address City Stale Zip � <br /> � � <br /> iyL,, - �� f - -����_z_ _ s t._.�'!y s�.,�� . �, C�/� �� ,�, .1. � � ,� <br /> i Phone Emad <br /> - — - - -- - — -_ -- ---� <br /> I, Ihe Vendor, agree lo receive the Backwater Prevention Device rebate check duecdy tor the <br /> inslalia6on a� the above referenced property address. By agreeing b receive the rebale check <br /> directly, I aaree to the following: <br /> 1 The Backwaler Prevenlion Device rebate amount w.ill be deducted from lhe f�nal invoir.e <br /> given lo ihe property owner for the inslallalion al lhe property address referenced above, if <br /> Ihe total cosl of the installation is greater than the rebate. ' <br /> i <br /> 2 I, the Vendor, am a Washinglon Slale licensed contractor. ; <br /> 3. Ihe City of Everett will send a Federal Porm 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate payments totaling more ihan $600 per r.;dendar year, and will <br /> report the same paymenls lo Ihe Inlernal Re:venue Service. <br /> ( . _ _ _ <br /> ' I accepl the paymenl of Ihe 13ackwater Prevenlion Device rebate from lhe Cdy o1 Everetl pending <br /> approval o( the completed Backwaler Prevenlion Device rebale packaye by the Cily ol Everel� <br /> � ��-. <br /> I ����.�''�� �� - �7 - /j <br /> SignaWre of Contractor Dalc <br />