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i <br /> ; <br /> � <br /> i <br /> i <br /> Con4rac4or Section: <br /> � <br /> I <br /> i <br /> M u�r ��I�,h �,n G U � C-:��� c-;�-( i <br /> Vendor Name/Business Na �e! U81 Number � <br /> i <br /> �"luc'.�1 ��'-� S'Sf > J� i <br /> I <br /> State of Washington Contractor License Number: ! <br /> i <br /> I 7S I $ �l( `�� 51-. Sr S��u�or`+� t� l✓�4 ��Z-`� U ': <br /> Vendor MaiHng Address City Stele Zip I <br /> . , <br /> W � 5� 7C•U �?� O I'i-en�'CJ 'r� u[JI� f�Ii,,,til��r��.� c�vh i <br /> Phone Email � <br /> i <br /> I, the Vendor, agree to recelve the Backwater Preventlon Device rebate check dlrectly tor the I <br /> installation at the above referenced property address:By agreafng to receive the rebate check ! <br /> dfrectiy, I agree to the following: j <br /> 4 <br /> 1. The Ba�Mvater Prevention Device rebate amount will be deducled from 1he final involce I, <br /> given to the property owner tor the fnstallation at the property address referenced above,If <br /> the total cost of the installation is grealer than the rebate. • <br /> 2. I,the Vendor,am a Washington State Iicensed contractor. <br /> 3. The Ciry oF Everett will send a Federal Form 1099 MISC to me,the Vondor,tor Back�vater �� <br /> Prevenlion Deti4ce rebate paymenls tofaling more lhan 5600 per calendar year, and eaill I <br /> repart lhe same payments to the Inlernal Revenue Servlce. ' <br /> i <br /> I <br /> I accept the payment of lho Backwater Pre�enUon Device rebate from the Ciry oF Everett pending <br /> opproval of thQ completed Bockwater ProvenNon Devico rebalo package by the City of EvoreU � <br /> I <br /> i <br /> � i <br /> ;`"�� `'�'�/�j2c�.--- `'1— i S ' I S � <br /> Signaturo of Contraclor Date ` <br /> ; <br /> � � I <br /> j <br /> ; <br /> � <br /> i <br /> . i <br /> • f <br />