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Contractor Section: <br /> ��LG.C'L1�t�.+�►!�L n/G _ �,� -u/ 3 - �5 Sl <br /> Vendor Name I Business �ame(UBI Number <br /> �tr1L��L_7__Ci�..L I <br /> State of Washington Contractor License Number: <br /> S �� -��—^�_i:_—_��s .5 v� �.—W�__�5.�7� <br /> Vendor Maflin�Address City Stato Zip <br /> L���1�SS7—'1.��/7 _ _ — <br /> Phone ' Email <br /> I, lhe Vendor, ogree to receive the Backwater Preventi,�n Device robato chock directly for lhe <br /> inslai!a(ion et the above referenced property address. By agreeing to receive ihe robate check <br /> dlrecUy, I agree to'he folloe�ir.g: <br /> 1, The Backwatc�r Provention Device rebata amount�vill be deducted from the(inal invelce <br /> given to Ihe preperty ovrner for the installation at tho property address re(erenced abov2, If <br /> the total tost oF the Installatlon is greater lhan tha robate. <br /> 2. I, the Vendor, am a Washfngton Slate licensed contractor. <br /> 3. Tho City of Everett wlll send a Federal Forrn 1099 MISC to me, lhe Vendor,fnr Bar.kwalcar <br /> Prevenlion Devic� rebato payments totaling mnre than 5600 per calendar yoar,and�vill <br /> report lhe same payments to tho Internal Revenue Servlr,n. <br /> I accept ihe payment of lhe Oackwaler Prevention Devico rebate(rom the City of Fverett pending <br /> approval of ihe cornpinled Back�vafer Prevenlion Deviee retnte packaye by ihe Ciry of Everett <br /> � <br /> 0 <br /> ' ----- - ' �--�- <br /> Signeture of Controctor �._. Dato <br /> I <br />