Laserfiche WebLink
i <br />Contractor Section: <br />Vendor Name / Gusiness Namo / UBI Number <br />State bf Washington Contractor License Number: <br />_ !� cs�2�✓GZIK� f'1 ✓[":'_ <br />Vendor Mailing Address <br />l`Z�� <br />Phone <br />Email <br />�� �i (0 '-� <br />City State Zip <br />I, the Vendor, agree to receive the Backwater Prevenlion Device rebale check directly for the <br />installation al the above referenced property address. By a�reeing to roceive the rebate check <br />directly, I agree to thc foliowing: <br />1. The Backwater Prevenlion Device robato amount will be deducted from Ihe final invoice <br />given to the property owner for ihe installalion al the proporly address rcfcrenced a6ove, ii <br />the total cost of the installation is greater than the rohale. <br />2. I, lhe Vendor, am a Washington Stale licensed cornractor. <br />3. The Cily of Everelt will send a Federal Form 1099 MISC to me, the VenAor, (or Backwaler <br />Prevcnlio� Device rehatc paymenls tohling more lhan �G00 per calendar year, and will <br />report lhe same payments lo the Inlernal Revenuc Service. <br />I accopl the payment of lhe �ackwater Prevenlion Device rebate from fhe City of [verell pending <br />approval oF the compleled Backwaler Preve�nlion Device rebata package by Ihe Gity of Evr,rott <br />�� � i' � �/ <br />S ture of Contraclor Dalo <br />�.C�"^ <br />