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i <br /> i <br /> I <br /> � <br /> I <br /> I <br /> Contractor Section: <br /> -- --- ---- <br /> --- - - - _ __ <br /> � ��Ct�,Yl�_��. -cC�`ii�,__`_ ��zh'l� �-C- _ Cv=''' 1`'r-�:35 � <br /> i Vendor Namc�I Busine5s Name I Udl Numb�:r • <br /> � <br /> ' .�.1`�- �_�i�.I �`� -�-�-� - ��-�' __ - - - -- - - - _ _ ; <br /> Slate of Washmgton Coniraclor License Number <br /> �?la��L4r_�iL'1_—�1',�_ —_�t��'_r�:1�I,��__�'�.�� i <br /> Vendo� Mailing Address Cily Slale Zip <br /> ��_���..ac�4� ��«xJ�r_ic.�.���_ ���l�r�._c�2— <br /> Phone Email ; <br /> ---- ---- - - i <br /> I, Ihe Vendor,ayree to receive the Back�vater Prevenlion Device rebate r,heck directly tor the � <br /> installalion at the above re(erenced properly address E3y agreeing to receiva the rebate check I <br /> directly, I ac�ree to the followin9 j <br /> 1. The Baclavator Prevention Dewce rebate amount will be deducted from the final invoice � <br /> given lo thr. properly owner for Ihe installalion al the propeRy addresc referenced above, if i <br /> the lolal cost of the inslallation is gmater than tha rahate � <br /> 1 <br /> 2 I, Ihe Vendor,am a Washinglon State lir.ensed conlractnr. I <br /> 3 The City af Fverell wil�send a Federal Form 1099 MISC to me, the Vr.ndor, (or Rackw�ter � <br /> Prevenlinn Device rebate paymenls totaling more than n600 per calendar year, and will <br /> report Ihe same paymenis lo ihc Internal Revenue Sen�ir.e j <br /> i <br /> - - — - -- -- <br /> i <br /> — --- <br /> - - - - - - i <br /> I acr.ept the paymenl 01 1he Backwaler Prevention DevicR�ebate from the City of Everetl pending � <br /> aUProval of ihn r.ornpleted Backwaler Prevention Device rebate par.kage �y lhe City of Everetl � <br /> ; <br /> �l � <br /> �_�- �r'�-'-�--��— — — - `��`�'���_ _ _— <br /> Signalure oi Contracror Date � <br /> I_-- - -- ---- -- --- - -----__- ---- ---- i <br /> i <br /> i <br /> I <br /> i <br /> � <br /> � <br />