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i <br /> - ; <br /> � <br /> � <br /> � <br /> Contractor Section: � <br /> �n.,,�t��rr - �+�rjl; n.rrl �[rl� 4>..Yr I,LC'. (��„2 -�.�?3� <br /> Vendor Name!Business Name/U81 Number � <br /> �AMz�-cS�I K� I <br /> State of Washington Contractor License Number: <br /> ��:�?o l.c r l� n �� Ei.t-1L� I.�fl G)�'.v i <br /> Vendor Melling Address Clly Stata 7Jp <br /> ,�-- '?_rn '�(�.;� �'�/41'�iRIYW.(`i[tth�L�.Sl� .�'.c�Yl <br /> Phane Eme(I <br /> � <br /> I,the Vendor,egree to recefve the Bee,kwaler Preventlon Device rebete check diredly for the � <br /> InstallaHon at the above referenced prOperty address.By agreeing lo receWe the rebate check <br /> direcUy, I egree to the following: : ( <br /> 1, 'f►ie Backwater Provention DeSica rebate amount wlll be deducted from the final invoke <br /> given to Ihe property owner fo�tlie Inatelle0on et Me properry addrass referenced above,if <br /> �� the totel cost ol the Instalietion la greeter ihen lhe rebate. � <br /> 2. I,tha Vendor,em a WashingWn Stete Ilcenaed controctor. <br /> 3. The Cfly o(Evarelt will sand a Federsl Form 1098 MISC 1„ ie,lhe Vendm,iw Backwntur <br /> PrevenHon Davice rebate peymente totaling more then SBW per calendar yeer,and w�ti <br /> repoR the seme payments to Ihe Inlemal Revenue Service. <br /> I eccept the payment ot the Beckwater Prevenlion Device rebete hom the City of Everett pending <br /> approvel of the completed Beckwater Prevention Device rebate package by the City of Everett <br /> ���' ' f C.�v� �-4�i-�'_— <br /> SlgnaNre of Coniracta Date <br />