Laserfiche WebLink
Contractor Section: <br /> � <br /> /�Y:�I.L��GLLr']i� ��tJv (�J ~G/ � – C�SS� <br /> Vendor Name/Business Name I UBI Number <br /> , <br /> ' -� �� �'� '` — <br /> State of Washington Coniractor Lic2nse Number: i <br /> s�o7 ��5'"A�, ,v� M/�,zvsv���_;, w�7 9.��.70 <br /> Vendor Mailing Address City State Zip <br /> (�/�S) ��57 •�1�c•7 <br /> Phone ' Email <br /> � <br /> I, the Vendor, agree to receive the Backe�ater prevention Device rebata cneck directly fcr the <br /> inslallation at the atovo referenced property address. By agreeing,o receive the rebate check <br /> diractiy, I agree to the follotving: <br /> 1. The Back�rater Prevenlion Device rebate amount will be deducted irom lhe final invcica <br /> given to �he propsrty oivner for the installation at the property address referenced abova, if <br /> lhe totai cosl of Ihe installatlon is greater i"an the rebate. <br /> 2. I, the Vendor, am a iNashington Sta!e licensed contracfor. <br /> 3. The City of Everett will send a Federal Form 1099 Ni(SC to me,the Vendor, tor Back�valer <br /> Prevention Devico rebate payments totaling more than 5600 per czlentlar year, and�vill <br /> repoR the same payments to ihe Internal Revenue Service. <br /> i <br /> I accept the payment of the �ackwater Prevenlion Device rebate from the City of Everett pending � <br />� approval of lhe compleled Dackwater Prevention Device �eba'c packaae by th�City o(Lverelt <br /> ` �r." �7 "` } <br /> Signature of Conlractor ,... D2te <br />