Laserfiche WebLink
, <br /> i <br /> � <br /> i <br /> t <br /> � <br /> 1 <br /> I <br /> � <br /> Contractor Section: � <br /> -- � <br /> � �—v i� � 'il�' L►—C � lva2� � 5�180 � <br /> Vendor Name/Business Name/ UE31 Number � <br /> � <br /> � <br /> �w�r� L�II.� mrJ I <br /> State oi Washington Contraclor License Nun�ber: � <br /> i <br /> �(� �;�X .�-I � L I71�dti �Y�� w'l� `1����4�> ' <br /> ; <br /> Vendor Nailing Address City State Zip � <br /> U��1/1 l��'_ ��_ ! b Iu�i��SEW�r—�r lBVic� ��,�C01� s <br /> Phone Email ; <br /> I <br /> ; <br /> � <br /> I, the Vendor, agree to receive the Backwater Frevention Device rebate check direcGy for the i <br /> ins[allalion at lhe above referenced property address. By agreeing to receive the rebate check ' <br /> direclly, I agree to lhe following: <br /> 1. The Backwater Prevenlion Device rebate amount�vill be deducted from the final invoice <br /> given to ihe property owner for the installation at Ihe property address referenced above, if <br /> the total cost of the installation is greater than the rebale. : <br /> 2. I,the Vendor, am a Washington Stale Iicensed contractor. ; <br /> i <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater ; <br /> Prevention Device rebate paymenis lotaling more than 56D0 per calendar year. ,ind will <br /> report the same payments lo the Internal Revenue Service. ' <br /> I accept the payment of the Backwater Prevenlion Device rebate from the City of Everelt pending <br /> approval of the completed 8ackwaler Prevenlion Device rebate package�y the City of Everelt ; <br /> i <br /> i <br /> i <br /> �������� �-c�/����e i <br /> � <br /> Signature of Contractor Date � <br /> i <br /> — ; <br /> i <br /> � <br /> i <br /> ; <br /> � <br />