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- - -_ --_- ---------- <br /> -- _ - -------- -_ � <br /> . ( <br /> � <br /> Co�tractor 5eciion: , <br /> � ���r`_tC�Y-��`,'-�--{' ,. �-- / , ��.,s,wrLLC._�-�.�,�.�- :.��8 <br /> � Vendor Name!Business Name!U81 Number <br /> I ;�M►:f����.���c� l ' �,L— — <br /> IState of Washington Coo�ractor License Number: <br /> :ali�.Xc—�cz�1,�1-7J1�� �_LC'��T �1�fl Ay�'.._i <br /> Vendor Iviailing Addres^, Cily State Zp <br /> � :`a�u�-��c���c�—L'�--1 < <,, - ��zr,�Se�C.c� = �.<<�.�� <br /> � Pho�a Email <br /> `------ -- -- — _——J <br /> i,the Vendor,agree to receive the Backv:ater Prevemion Device rebate check directly for the <br /> insfallation al Ihe above relerenced property addre.ss. By agreeing to receive lhe rebale cher.l; <br /> directly, I agree to Ihe{ollov�ing� � <br /> 1. The 6ack�valer Prevenlion Device rebate amount�;�iil be deducted irom the finai invoice <br /> given lo Ihe pioperty uwner for ihe instailation at the. property address referenced •above, if <br /> the tolal co_�t af thc inslallatioKis greatr,r Ihan Uic rebate. <br /> ?. 1, the Vendor, am a Washington Slate licensed contraclor. <br /> 3. The City of Fvemlt will send a Federal Form 1099 MISC lo mc, the Vendor,for Dackwater <br /> Prr.vention Device re6ale paymr.nts tolaling more than 5600 per caiendar year, and will <br /> «�poit the same payments to the Internai Revenue Scrvice. <br /> � <br /> � I acr.ept thc payment of lhe Backwaler Prevenlion Uevice rebale trom the Gity ol Everet�pendmg <br /> approval of the completed Backwater Prevention Device rebate paekage by the Cily of Everetl <br /> �`� . <br /> �. , ��.-.� _ta���--- <br /> ISiynature of Coniractor Date <br /> � -- -- — -- — - - -- I <br />