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i <br /> ' I <br /> 1 <br /> ! <br /> i <br /> i <br /> i <br /> � Contractor Section: ; <br /> �'q�''iC��D---� - __ --- �„�—�� -�-�c-�LL-C. ��:� ; ���3 I <br /> Vendor Namo I Qusine s Neme!UBI Number i <br /> � <br /> —1�'-1--{yJ-���--d-""--`1�� -�— ---- —�---- j <br /> State oi Weshinglon Contractor License Number: ' <br /> �r���4rJ,��--�-����✓�r�i������i'��� ' <br /> � <br /> Vcador Mailing Address CiP/ State Zip ' <br /> �fe-�1.��Q-��'�►'k��_('�_c���- �:�• _�c�D� C.r-,�'I i <br /> Phone Email <br /> � <br /> _.� . — -- � <br /> i <br /> I,Ihe Vendor, agree lo receive the Backwater Prevention Device rebate check directly tor the , <br /> installation at Ihe abovo referenced property address.By agraeing to recoive lhe rebHte check � <br /> dir�r,tly, I agree lo the followm�� <br /> 1. The Bar.kwaler Prevenlion Device rebate amount will be deducled from the final invoicn � <br /> given ro the proporty ownrr for fhe instellation at ihe property addross refcrenced a6ove,if <br /> the total cost of the installafion is pre�ter than Ihe rehate i <br /> 2. I, the Vendor, am a Washington Statn hcensed conlractor. i <br /> 3. Tho Gty�I[verott will sond� Fedaral farm 1099 MISC to me,Iho Vendor, for Backwnlnr <br /> Prevontian Device rebato payments tolaling more than $fi00 par calendar year, and will <br /> report the same payments lo iho Internal Revenue Service. ; <br /> i <br /> -- ---- — i <br /> -- --_- . _ _—..—.. ..__ . .. .- - -- - —� � i <br /> I ar.r.ept lhr,payment of the Backwater Prevenlion Device rebat�from Iha City of[ve�etl pendinc� i <br /> approvai ol Ihe compleled Backwaler Prfrvenlinn Dnvicr. rebale packayo by lha City of Everell i <br /> i <br /> I <br /> ���:.�. ._ � � --�-- —_ - �1a����= -- -- ; <br /> Si�nalurr.of CoNrar.lor Date <br /> � <br /> i <br /> I <br /> � <br /> � <br /> . � <br /> 1 <br />