Laserfiche WebLink
Contractor Section: <br />Vendor Name / Business Name /,U31 Number <br />��Ci7'K� r <br />Stale of Washington Co tor License <br />� <br />� !/ l l !%Z�y1GC �'%�-�Y-Gr�L�� !if/�'" �� � E� <br />Vendor Mailing Address City Stale Zip <br />Phone <br />8 <br />Email <br />I, Ihe Vendor, agree to receive the Backwater Prevention Device reba�e check directly for lhe <br />installation at the above referenced property address. By agreeing to receive the rebale check <br />directly, I agree lo the following: <br />1. The Backwater Prevenlion Device rebate amount will be deducted irom the final invoice <br />given to ihe property owner for lhe installation al lhe property address referenced above, if <br />lhe total cosl of the inslallation is greater than lhe rebate. <br />2. I, lhe Vendor, am a Washington State licensed conlractor. <br />3. The City of Everetl will send a Federal Form 1099 MISC to me, Ihe Vendor, for Backwater <br />Prevention Oevice reCate payments totaling more lhan �600 per calendar year, and will <br />report the same payments to the Intemal Revenue Service. <br />I accept the paymenl of the Backwater Prevenlion Device rebale from the City of Everetl pending <br />approval of the completed Backwaler Prevention Device rebate package by the City of Everett <br />i n �__ <br />Signature of Contractor <br />�/ 30.� 5�-- <br />Date . <br />Cqn� <br />