Laserfiche WebLink
Contractor Section: <br />i YG//Ci /��� ��i� G/3 GS�f <br />Vendor Name ! Business Name / UBI Number <br />�i���Lp�� L� -- -- - <br />State of Washington Contractor License Number. <br />S�.e: 71s—` f°v_� .'' =-- ''�a,�d.,ie wit ,�s 2_7ci <br />Vendor Mailing Address City State 7_ip <br />Phone Email <br />l, the Vendor, agree to receive the Back�vater Prevention Device rebate check direcUy (or the <br />installation at the above referenced property addre.ss By agreeing to receive the rebate check <br />directly, I agree to the folloaving: <br />1. The Backwater Prevention �evice rebate amount will,be deducted from ihe final invoice <br />given to the properfy osvner for the in�tallation at lhe propeAy address referenced above, if <br />lhe to�al cost o( Ihe installalion is greater than the rebate. <br />2. I, the Vendor, am a Washinglon State licensed conhaclor. <br />3. The City of Everett �vill send a Federal Form 1089 MISC lo me, the Vendor, (or Backwater <br />Prevention Device rebale payments totaling more than 5600 per calendar year, and will <br />report the samc payments to lhe Inlernal Revenue Service. <br />I accept the payment oi the Back�vater Prevention Device rebate from the Ciry of Fverett pendmg <br />approval ot the compleled Backwater Pievention Devir.e rebate par.kage by lhe Cdy ol Everelt <br />Signa�ure o( Contraclor <br />?����n//.� <br />Date <br />