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i <br /> ; <br /> ConYra�sior �ecQion: ' <br /> / ^� � <br /> r'�CC./� I ��tn rti ��I�t.� C% �� :�C L>�'C% � �-/,� ---- � <br /> - i <br /> Vendor Name!Rusiness Na e/UBI Number ' <br /> � <br /> i <br /> Nl u r n �/'.� ��- ; �r� _ ------ - — : <br /> Stete of Weshington Contractor License Number: <br /> 1 7S 15 �I�'-'� 5 . SE 5���11uL�,� t�,-- l✓/4 ��7`) U . <br /> Vendor Meiling Address City Stale Zip <br /> �l �• S' 7L• U S�Y(,.(� "1 r[a��'�i,' r� �.Cn ���,,,�,�j�r� c��i�� --- '. <br /> --- �- --- —`�' "- - i <br /> Phone Email <br /> - — — — � <br /> I, the Vendor, agree to recelve the Backwater Prevent�on Devica rebate check directly tor the ; <br /> installation at ihe above referenced property address. By aqreeing to recelve the rebate check i <br /> direclly, I agree lo ihe follov�in�: <br /> t The Backwater Prevention Device reh�te amount will be deduoted from the final invoiCe <br /> qiven lo Ihe property owner tor the fnslallatlon et!he property address reterenced ebove, If j <br /> the lotal cost of the installalion is greater than ihe res6ale. i <br /> 2. I,ihe Vendor, am a Washinglon Stale licensed contractor. ; <br /> 3. Tho City of Everett will �end a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention �evice ir.bale payments totalin,y more thaa$G�0 per caiendar yeor,and wili � <br /> reUurt lhe same payrnenis to Ihe Intemal Revenue Service. , <br /> I accept th� payment of tha Back�vater Prevention Device rebale irom the CVty of Everett pending ; <br /> � :ippurvr�l u1 Ilui r.omploted [leckwaler Pravr.nllon Uovlce rr�bate par,kngo by thr�City of Evcrett , <br /> f <br /> i <br /> � �.���� p���7`iiC,•'— � ' (� ��� . <br /> __�____ _-- . ' __._--_____."'—_ ' <br /> Signaluro oi Contractor Datc <br /> . <br /> -- -- ---- ------ -- --------------- � <br /> � <br />