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i <br /> ConMactor Section: � <br /> I <br /> �„HClof�i� ('��r'� 'r n � Si�/�t � Y/�f���'� 6 Ll- Sg I <br /> Vendor Name J Business Name/U81 Number <br /> i <br /> �M��'��SS �o I K L_ <br /> State of Washington Contracior License Number. <br /> ��Cd�'o larl�Q ,t�,P E�.r� �,c)fl G1�z3 <br /> . Vendor Mailing Address City State Zip <br /> �lCL�C�� �'�:�r���,����� � � <br /> Phone Email <br /> � <br /> 1,tAe Vendor,agree to receive tha Beckwater Preven6on Device rebate check directly for the <br /> installation at the above referenced prbperty address.By agreeing tn receive the rebate check <br /> tlirectly, I agree to Ihe following: � <br /> 1. The Backwater PrevenNon De yI ice rebate amount will be deducted from the final invoice <br /> given ro the pmperty uwner for!the fnstallatlon al the property address referenced above,if <br /> -' the totel cost of Me InsfallaBon'is greater then the rcbata. . <br /> 2. I,the Ve�or,em e Wash(ngton Stete licensed contractoc <br /> 3. The City of Everelt will send a Federal Fortn 1099 MISC to me,the Vendor,for Backwater ' <br /> Prevenfion Device rebate payments tofeling more than 5600 per calendar year,and will <br /> report the same payments to lhe Intemal Revenue Service. <br /> I accept the paymant of the Beckvuater Prevenlion Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by fhe City of Everett <br /> �' �--�'� �� <br /> Signature of Contractor Date <br />