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_ _ . <br /> i <br /> . .., . : . . ; <br /> . �,. , ; <br /> . � , � :, � <br /> � : ; r <br /> , � <br /> , , : ,. � , <br /> , <br /> c s, i i <br /> Contractor Sec:ion: i <br /> i <br /> _ i <br /> q i <br /> ��I'LT1S �l Cl� L�a-�l_t �974 ��u� pi�9 �.0 (o0'L-7d'Z�l � <br /> Vendor Name/Business Name!UBI Number f <br /> f <br /> ��4�1u/�'O//P/� I <br /> StatQ of Washington Contractor License Number: ! <br /> ��ll �! c Y�#.l�C' �� -�l�rr,t�— W9- 9�11� ; <br /> Vendor Mailing Address City State Zip ; <br /> 42:su8`�`�(Z� �t4�� �v��� LG_G�V7�C-tmrnLuC � <br /> Phone Email � <br /> ; <br /> �_ I <br /> i <br /> I <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebale check direcUy�or the � <br /> instalialion at lhe above referenced property address. By agreeing to receive the rebate check � <br /> directly, I agree to the following: ' <br /> � <br /> 1. The Backwater Prevenlion Device rebate amoi�nl will be deducted from the final invoice j <br /> given to the property owner for the inslallaGon at the property address referenced above, if � <br /> Ihe total cosl oi Ihe installalion is greater than the rebate. <br /> 2. I, lhe Vendor, am a Washinyton Slate licensed contractor. ; <br /> 3. The City of Everetl will send a Federal Form 1099 MISC to me,the Vendor, for Backwater i <br /> Prevention Device rebale paymenls tolaling more than$60D per qlendar year, and will ; <br /> report the same paymenls Ig Ihe Internal Revenue Service. i <br /> I <br /> ---- ----- — —----- � <br /> � <br /> I accept the payment of the Backwater Prevenlion Device rebale from lhe City ot Everett pending i <br /> approval oF the completed Backwater Prevention Device rebate package by lhe Citybf Everett <br /> i <br /> � <br /> � <br /> � <br /> /i' �' ' <br /> �^ ��-12—t S� ; <br /> — _ , <br /> Signature of Contrador Dale <br /> � <br /> ----- — --• � <br /> : . : <br /> , 1 <br /> ' I <br /> � � � <br /> • � <br /> i <br /> i <br /> _ i <br />