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i <br /> . ; <br /> ; <br /> i <br /> �ontractor Section: � <br /> I <br /> _- -- — --- -- <br /> � <br /> — ------ -- � <br /> �la'1�''�a�- ` ' . �-��.—.��-��C..'('�-�Lc.. __(y>c.�-���'.3 � <br /> Vendor Name I Busine.s Name I U81 Number ' <br /> I <br /> �1'l E I�Z.`����-IvJ—X �-- -- - --—--- � - -— � <br /> Slate oi Washington Contractor License Numbec � <br /> i <br /> �o�__Lac���i�n,�._��/��"_���---�'-�'�� ; <br /> Vendor Mailing Address City Stale ZiP � <br /> . ' I <br /> aL�(c'r.�7n�?�g�_L1Y1c1� 1_c,L'._a.�?�1-��-�-'�* ��1D�'S oi?7._ - i <br /> Phone Email ' i <br /> - ------ - -- - -- --� i <br /> I,lhe Vendor, ayree lo receive the f3ar.kwater Prevention Dewce rebate check Airec�:y for the � <br /> inslallation al the above referenced property addrass. By ag�eeing to receive the rebale check i <br /> direclly, I agree lo the follo�ving <br /> 1. The Backwater Prevention Device rebafe amount will he dr.Aucted from the final invoice � <br /> yiven to Ihe property owner for the inslallalion at the property addrass refcrenced obove, if ; <br /> the total cost of thc Installatinn is greater than Ihe rehate 1 <br /> ; <br /> z. I, the Vendor, am a Washington Ste��licensed contractoc � <br /> 3. The Cily of Fverett will send e Fedr.ral Farm 1099 MISC lo me, Ihe Vendor,for Aackwater i <br /> Prevenlion Device rebate paymeNs totaling more than $600 per calendar year, and will i <br /> report flie same paymenis to Ihe Internal Revenue Service , <br /> i <br /> I acr.epl the payment of the Rackwater PrevenGon Drvice rebate from Ihe City of Fve�ett pending � <br /> approval of ihe completed Clackwater Prevention Devir,e rebate package hy the City of Evc�ett i <br /> � 1 � <br /> ��_--- ��_.�_ _ _ ����-�lt�- � <br /> Slgnalure of Contraclor Oate � <br /> — ----- -- -- — — -- — --- -- - -- � <br /> . i <br /> � <br /> . j <br /> i <br />