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�c8P14PdGkOY a0�$1019: <br />i��,-,� ��I�,� h�,� <br />Vendor Name /�Business Nart%1 UBI Nurnber <br />h'� li t'l1 i� %� �e S�� '� J[,) . <br />Stolo of Wachinglon Contrador License Number: <br />i�S � s �rl''� Sh. SC Sr�,;�,o��� sl, _ �✓Ik ��5`7—�c, <br />Vendor Ma��ing Address Ciry State Zip <br />�1 �. s 7 �:� v s�3 <br />Phone <br />Email <br /><<, <br />I, the Vendor, agree to receive lhe Bacl��Jaler Preventlon Device rebate checic directly for the <br />installation at the above referencad properfy address. By agreeing to recelve the rebate check <br />direclly, I agree to the folloiving: <br />Z. <br />3. <br />The Bacicwater Prevention Devicz rebale amount vdilt be deducied from the final invoice <br />given to the property owner for the insiallation at ihe property address referenced above, iF <br />the lotal cost of the installation is greater Ihan the rebate. <br />I, tlie Vendor, am e Washington State Ilcensed contra�tor. <br />The CiD/ of Everett vifll send a Federal Form 7099 IUISC to me, the Vendor, for Bacinvater <br />Prevention Device rebate payments totaling more than $60D per calendar year, and ivlll <br />report lhe same p2yrnenls to the Intemal Revenue Service. <br />I accopt ihe payment of the Backwaler Preven6on Oevice rebate from lhe City of Everetl pending <br />: ipproval of ihe compleled Dackwotnr Prr.ventlon Dovicr. robale p:�ckape by tha City of Evemtt <br />', u,�� ''�'i1���.�-- 6-��-rl <br />Signaturo of Contractor Date <br />