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Contractor Section: <br /> i(l�Yl �l�hC ������ 6 L`;�.'�i� �' (��'2 -��g <br /> Vendor Name/Business Name/UBI Number <br /> �M��' �Sz�o I Kl— <br /> Sfate of Washington Contraclor License Number: <br /> _ �at�'o +-�rl� ��� . Ei.��F I,�fl q�� <br /> Vendor Mailing Address City State Zip <br /> ��1�._�CC� �'" Y,i�,�}i1'l".(`iCtiyl��l�F�'i��i��t'. -C�I177 <br /> Phone Email <br /> I <br /> I <br /> I,the Vendor, agree to receive the Backwaler Prevention Device rebate check directly for the <br /> inslallalion at the above referenced property address. By agreeing to receive the rebate check <br /> AirectlS•, I agree to the following: <br /> 1. The Backwater Prevention Derce rebate amount will be deducted from ihe final invoice <br /> given to the propeRy owner for ihe ins[alla6on at the property address referenced above,if <br /> � the total cost of the installation�is greater than the rebate. <br /> 2. I,the Vendor, am a Washington State licensed contractoc <br /> 3. The City of Everett will send a Federal Fortn 1099 MISC to me,the Vendor,for Backwater <br /> Prevention Device rebate payments tolaling more than$600 per calendar year, and will <br /> report the same payments lo the Inlernal Revenue Service. <br /> I accept the payment ot the eackwater Prevention Device rebate from the Ciry of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by Ihe Ciry of Evereri <br /> ���� � <br /> Signature of Contractor Date <br />