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i/ � <br />Contractor Section: <br />A+ Sewer Technologies <br />Vendor Name I Business Name / UBI Number <br />603 089 164 <br />State of Washington Contractor License Number: <br />900 Meridlan Ave E STE 19-193 Milton WA 98354 <br />Vendor Mailing Address City State Zip <br />(868) 213-7656 infoCosewertechs.com <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Preventan Device rebate check direcfly for the <br />installation at the above reterenced propefty eddress. By egreeing to receive llte rebate check <br />dfreclly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted irom the iinel invoice <br />given to ihe properly owner for the insfallatlon at the property address referenced above, if <br />tho lotal cost of Ihe inslaUaliOn is greater ihan Ihe rebate. <br />2. I, !'ie Vendor, am a Washington Slate licensed contractor. <br />3. Th; City of [verett wlll send a Feclerai Form 1099 MISC to me, the Vendor, for Backwaler <br />prevention Device rebate payments totaling more lhan $600 per calendaryear, and witl <br />report tho samo paymonts to the Internal Revenuc Scrvicc. <br />i accept the payment of tho Backwaler Prevenlion Devlce rebato irom the Cily of Everett pending <br />approval of the completad Backwater Prevention Device rehato packege by the Ciry of Everett <br />W�Iy, �'° `,�wie�n.�m <br />L f a..nuw.�ma+�eu <br />..� <br />.A' onew�f�u.isa�ou�!am <br />Signalure of Conlractor <br />..� y-/s <br />Date <br />