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Contractor Section: <br /> ��C,!'�-,--.`�' -- �'� . � �� �.it7�� LLC:� �cj_', .�.q.:.�.3� , <br /> Vendor Name f Busine s Name/UBI Number ! <br /> _���aZ.`J-���-�-�-- -- _ � <br /> Slate of Washington Coniractor License Number. <br /> ,�(�G� L.ca r li����a= {�Nt�re��_��i�i"k�G�- , <br /> IVendor Mailing Address City State ZiP <br /> p��p_-9'Y�()�C�g� �1�iS LC-G_.��� c.J' . �.Cl/'.�Z._ , <br />, Phone Emaii <br /> I,the Vendor, agree to receive Ihe Backwaler Pre�enlion Device rebate check directly fnr the � <br /> installation at lhe above reterenced property adJress. By agreeing to receivo fhe rebale check <br /> directly, I agree to the tollovring <br /> 1. The Backvlater Preven5on Device rebate amount�vill he deducled from the final invoico ' <br /> given to the property owner icr the installation at the prope�ty address referenced above,if <br /> the total cost of the installation is yreater than the robate. <br /> 2. I, Ihe Vendor,am a Washington State Ifcensed contraclor. <br /> 3. The Ci1y oi Everett w�ll send a Fedr.ral Form 1099 M�SC to me, the Vendor, for Etackwater <br /> Prevention Dovico rebato paymenls lolaling more than 5600 per calendar year,and will <br /> report lhe same payments to Ihe Inlernal Revenue Service. <br /> I accepl the paYment of 1he Dackwaler P'reventinn Device iehate from the City ol Everelt pending <br /> approval of Qie completed Back�valer Prevenlion Devir.e rebate p.ackage by the Ciry oi Gverett <br /> i <br /> C����_�'��'_ — --�a.����____ ' <br /> Si�nature of Contractor Date <br /> i <br />