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i <br /> � <br /> ; <br /> � <br /> , <br /> � <br /> ► <br /> � <br /> Contractor Section: <br /> �--- -- <br /> -- -- --- <br /> — --- ----- — --- <br /> ` . <br /> ��iG.�-►'�--�?�"c� �--��t� 'i.c_�_LLc� .���-.'�_3t�}�:3 , <br /> • Vendor Name I Busine s Name/UBI Number � <br /> i <br /> �' _9_M�_.C�.���--�� -�� ` <br /> _ ____ _ ; <br /> State of Washington Cnntractor License Number: ! <br /> i <br /> �l��o(� -I-4_cl��_-QP,,_�.t�L�l�1f _�c7���i'fi'��_ i <br /> Vendor Mailing Address City State ZiP : <br /> �'� i_U-C�-��?al- s�_ C(-��C1II�SC�-- � <br /> aL�=�l��a�L���__.—�__►� �l <br /> Phono Email � <br /> 1, the Vendor, agree to receive ihe Backwater Prevention Device rebate check directly inr the � <br /> installation at Ihe above referenced properly address. By agreeing to receive the rebate check ' <br /> directly, I agree to the folloenng � <br /> 1 <br /> 7. The Backwater Prevention Device rebate amuunt wiil be deducted from Ihe Gnal invoice : <br /> given lo thc property ownar(or Ihe mstallation at the property aAdress relerenced above, if ! <br /> the tolal casl of the installation is greater than Ihe rebale. � <br /> 2 I, lhe Vendor, am o Washington State licensed contractor. 1 <br /> � <br /> 3. The Cily of Everett will send a Federal Form 1099 MISC to me, fhe Vendor, for Aar.kwate.r i <br /> Prevention Devica rebate payments tota6ng more than $600 per calendar year, and will { <br /> reporl the same payments to ihe Internal Revenue Service , <br /> I <br /> - ------- - - i <br /> — _ — --- — — -- i <br /> I ar.cepl the paymenl of Ihe B:�ckwaler Prevention Dt�wce rebale from Uio City of Evemtt pending i <br /> apUroval of the completed Rar,kvraler Prevention Device rebale package by 11tB L'dy Of Ev2rett , <br /> � <br /> C�'� _���;,�' -- - - - - -�� ��- ; <br /> Uate <br /> Signature o(Conlractor ' <br /> , � <br /> I <br /> � <br /> i <br />