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Contractor Section: <br /> ��LO J�.u.Ml��n/c' /�.'> —Gl � - !'rSS'� <br /> Vendor Name J Business Name/UBI Number <br /> , <br /> �y/LL �'G 5��� L j . <br /> State of Washington Contractor License Number. <br /> S '�o7 7 j/ ~i4✓o N�, M./�I�yS✓ill j W/3 Q4_,C7U <br /> Vendor Mailing Address Cily State Zip <br /> (vl;?S� ��s7 •�1�a7 <br /> Phone ' Email <br /> ' - <br /> I, the Vendor, agree to receive the Backtivater Prevention Device rebate check direolly tor the <br /> installation at the above re(erenced prope�;y address.By agreeing to receive the rebate check <br /> directly, I agree to the follo�•ring: <br /> i. The Backtivater Prevention Device rebate amount�vill be deducted irom the final Invoica <br /> given to the property owner for the instaliation at the properiy address referenced above, if <br /> the total cost of the installation is or2ater than the rebate. <br /> 2. i, the Vendor, am a Washington State Iicensed contractor. <br /> 3. The City of Everett�vill send a Federal Form 1099 MISC to me,the Vendor, for Backsvater <br /> Prevention Device rebate payments totaling more than$60D per catendar year, and r;ill <br /> report the same payments to the internal Revenue Service. <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everott pending <br /> approval oP the completed Backwater Prevention Device rebate package by lhe City of Everett <br /> � �'�J1� _ <br /> Sic�naturo of Contraclor Date <br />