Laserfiche WebLink
Contractor Section: <br /> (' � ►-1- � ( U Yvl�t_Y1-� 1.C,S �O 2- ��i Z - -1 3 <br /> Vendor Na e/8usiness Na ne UBI Number <br /> �� .l�_!_u.L��l./ � � � <br /> State of Washington Contractor License Number: <br /> �/� / '�"c�ut.ItlGi �1'�" =�l/�l Lt1�- �J�O� <br /> Vendor Mailing Address City Slate Zip <br /> '��2•,S' "rg'�'�lL a �: L2,1? .c�l� C..,�.�2� U� <br /> r, r� � L <br /> Phone Email � <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check directry for lhe <br /> installation at the above referenced property address. By agreeing to receive Ihe rebate check <br /> directly, I agree to the following: <br /> t. The Backwater Prevention Device rebale amount�•+ill be deducled from the final invoice <br /> c�iven lo lhe property owner for thr, inslallation al lhe property address referenced above, if <br /> the lotal cost of the installalion is yreafer than the rebate. <br /> 2. I, the Vendor, am a Washington Slate licensed coniraclor. <br /> 3. The City of Everett v�ill send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevcntion Device rebale payments totaling more than 5fi00 per calendar ycar, and�vill <br /> report the same payments fo lhe Inlemal Revenue Service. <br /> I� I accepl Ihe payment of lhe Backwaler Prevention Device rebate Irom lhe City of Everetl pending <br /> approval of ihe completed Backwaler Prevention Device rebale package by Ihe City of Everell I <br /> �'' ' �,.�' <br /> � <br /> ��;. _ � =,�� � S aS= IS <br /> Signalure of Contractor Date <br />