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Contractor Section: <br /> �-- - ------ - - -- --- - —- - - _ _ <br /> f'l o��,, I�l�, �,h��� � U � � k�1---`1�— <br /> iVendor Name I Rusiness Name U[31 Number <br /> M��n _�'P a���i 3.Tu -- -- -- — <br /> State o(Washington Contractor License Number <br /> I 75 i 5 �� � tf 5) Sr S�-,���,�.� cl� �`'� �1���,U <br /> i Vendor Mailing Address City Slate Zip <br /> i <br /> . � <br /> ' '-�1. � 7bU 4s' 36L� '�:<.� l « noc•i1r1 n��uiaJ[ • � �,�, � <br /> __..'_ . ._.____ _____._.. . .__._.__ _ _.. 'T-;T <br /> Phone tmail ; <br /> i, <br /> ! _. _ _ - - -- - - -- <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check directly for the <br /> installation at the above referr.nceA properiV adAress Ry agreeing to rer.eive the rebale chec'� <br /> directly, I agree ro Ihe foltowing: <br /> 1, The Backwater Prevention Device rebate amounl will be deducted from the final invoice <br /> given to Ihe property owner for the mstallation �t the propeAy address referenr:ed above, if <br /> t!'�e lotal cost o1 the installation is greatr.r ihan �he rebate <br /> 2 I, lhe Vendor, am a Washinc�ton State licensed contracror. <br /> 3 The Cdy of Everett will send a Federal Form 1099�dISC to mc,ihc Vendor, for Backwalcr <br /> Prevenlion Dr.vice rehate paymr.nls tnteling more Ihan$600 per calendar year, and will <br /> report th��samc payn:ents to Iha�Intornal Ruvr.nuc Scrvice <br /> I accept the p�ymr.N o(thc R�ckwater Prrvenhon Dev�rc rr.h�tr irom Ihc Gly nf Everett pending <br /> approval of the comFdeted �ackwater PreveMinn flavica rahale��acka�e by iho Cdy nl Everetl <br /> ��] {/ `'y/ � 7, � �-' ��" �� <br /> , ;/ "iL'_�'1� (/ . / �ZC.•'_- . - -----_._- <br /> iSignaWre o(Conlrector p°�O <br /> - -- _ - - -- <br />