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i <br /> . � <br /> i <br /> ; <br /> � <br /> � Contractor Section: I <br /> — - — -- <br /> —--- ---- <br /> - — - . <br /> �------ - � <br /> �,i�—`� � ' �" �.e�l' [Lc� —lu��', ,- �k�.3 I <br /> -r- ---- I <br /> Veridor Namo(Eiusine s Name/ UBI Number + <br /> � <br /> , � <br /> ��_-�.`�-`�-`�-�-�---�.�- - ---- — ! <br /> State of Washington Contractor License Number. I <br /> ��( �-_c�c LiL1-�$ F�L�1�� l,t��.� rt�k�C'>3. � <br /> Vendor Mailing Address City State Zip : <br /> i <br /> � CC-1� � <br /> ahb-�:LD��.$a2_.__��Y��C�-C�'._.c'1�2•3- "f ��' I <br /> Phone Email � <br /> ------ - � <br /> — � <br /> I, the Vendor, agree to receive the fiackwater Prevention Device rebate che�k direclly(or the � <br /> installalion at the above relerenced prope�ty address. By ayree�ng to receive lhe rebato check � <br /> direclly, I agree to the tollowing� <br /> 1. The Backwaler Prevention Device rebate amount will be deducted trom the final invofco ; <br /> given to Ihe property owner tor tha insmllation at the properly address reterenced above, il � <br /> the total cost of the installation is greal��r than ihe rebate. , <br /> 2. I, the Vendor, am a Washington State hcensod contractor. � <br /> 3. The City of[verett witl send a Paderal Form 1099 MISC to ma the Vendor, for Backwater <br /> Prevention Oevir.e rebate payme�ls tolaling moro ihan$600 per calendar year, and will i <br /> report U�e same payments to the Intemal Revenue Service. , <br /> I <br /> - —-- _ — _ —_-- <br /> __ — ---- � <br /> i <br /> I accept the paymenl of the Bar.kwaler Prevention Device rebale trom lhe City of Fverett pending i <br /> approval of the cnmpleted (lackv�ater Prevention Device rebate package by the City of Everett � <br /> i <br /> i <br /> �� � �� �J --- I <br /> C�-e�r�.�'_--- �r�--- —� ; <br /> Signature of Gonlractor Date ; <br /> i <br /> i <br /> I <br /> � <br /> � <br /> . i <br /> I <br />