Laserfiche WebLink
Contractor Section: <br /> �i;iLL�{� l�LuM j �Nrr (zJ.� —GI3 - ciSSr <br /> Vendor Name I Business Nan:e/UBI Number <br /> ( /�J�L f�G ylG i�L <br /> State of Washington Contractor License Number: <br /> S'�G] �7/jr/4Vc /Vi: /Y�/�livs✓rr�,s Vt//} ��f�70 <br /> Vendor Mailing Address City Staie Zip <br /> �"�.�.5� �r�S7 "%lS�CJ7 <br /> Phone ' Email <br /> 1, the Vendor, egree to receive the Backwater Prevention Device rebate check direclly for the <br /> inslailalion at the above referenced property address. By agreeing to rece(ve the rebate check <br /> directiy, I agree to the follo�ving; <br /> 1. The Backwater Prevention Device rebate amount will be dedu�ted from the tinal involce <br /> given to the propeRy owner for the installation at the property address referenced ebove, if <br /> the tetal cost of the installation Is graater than the rebate. <br /> 2. I, the Vendor, am a Wasliington Staie licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC fo mq U�,e Vendor, for Backwater <br /> Prevention Device rebate payments tolaling more than SG00 per calendar year, and eaill <br /> report the same payments to ihe Internal Revenue Service. <br /> I accept lhe payment of the Backwater Prevention Device rebate irom ihe City of Everelt pendinc� <br /> approval of tho completed Backwater Prevention Device rebate package by the Ciiy of Everett <br /> � - 3 -l� <br /> Signature of Contractor .,_. , Date <br />