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Contractor Section: <br /> �`''o�,� �?I�,� /�,,, GU � (vSl�; �-r�-!� <br /> Vendor Name/Business Ne e/UBI Num6er� � <br /> M G e!1 P�'* Ss k�)�_ I <br /> Slate of Washington Contrector License Number: I <br /> i <br /> � <br /> 17Si5 ��1-' S . 5E S,��hu��,� t�. �✓/E w,Y _�iU <br /> Vendor Mafling Address City State Zip � <br /> i <br /> `I � S 7L0 y�C-C% ?rr-n+�J �� �.Cn��l�,.-,hi��i� co�r <br /> Phono Emeil �— i <br /> i <br /> � <br /> � <br /> I,the Vendor, agree to rece(ve the Backwater Preventlon Devfco robate check directly for the ( <br /> (nstallation al the above referenced property address. 6y agreoing to receive the rebate check � <br /> directly, I ogree lo the following: � <br /> 1. The Backwaler Prevnntion Devico rebate amount will be deducted from the final invoice <br /> given lo the property owner for the installatlon at tt�e property address re(erenced above, it � <br /> lh�lotal cost of iha installation is greater than the rebate. <br /> I <br /> 2. I,the Vendor,um a Washington State licensed contractor. � <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me,tho Vendar, for Oackwater I <br /> Prevontion Device rebate paymants tolnling moro than$600 per calendar year,and will <br /> report Ihe same paymenis to the Internal Revenue Service. � <br /> i <br /> -- — -- -- I <br /> I ar,cept Ihe payment of iho Bar.kwater Pre�enlion Device rebalo trom the City of EvereU pending I <br /> approv�l nl the r.nmpleled Backwator Prevention Uevice rebato packac�u by the Cily of Everntl � <br /> I <br /> u� ��^�7� r I <br /> — G`'� - -- -- - U� �'����— � <br /> Signalure of Ccntractor Dale � <br /> i <br /> -- — - — -- --- — -- ; <br /> � <br /> I <br />