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Con:ractor Section: <br />LZKLi�t�iC1t-1�---`7L:�C���d�� _���c, ' -i-LL�'-c''�1�t v'3 <br />Vendor Name I Busine �s Name / UBI Numher <br />��'1-G_F;.L`�;�--`:i �'� --I;�_ <br />State of �Vashmgton Contractor License Number: <br />, �fP'_�l�'J L.Cd1� LJ <br />� Vendor tvtailing Address <br />Cily State Zip <br />I a��r��aLg� L��e�c+�Li_c�e�:� �%��l�0����2_ I <br />Yhone C-mail <br />I----- ---- -- - • <br />I. thr, Vendor, agree to receive the Backe�ater Prevention Devi� rebate check direcUy tor the <br />insta�lation at the a6ove referenced properiy address By agreeing fo receive Ihe rebale cher.k <br />cuectly, I agree to the tollov�ing <br />1. The Backwater Prevention Oevice rebale amount n�ill be deducted from lhe final invoice <br />given lo the propr.rty o:•:ner for the installa'ion at Ihc properly addrecs re(erenced above, if <br />the lotal cosl of the in,tallation is greater than lhe rebate <br />2 I, lhe Vendor, am a lNashington State licensed contractor. <br />3. The City of Fverett ;vill send a Federal Fonn 1099 MISC ;n me, the Vendor, for Backwatcr <br />I�revent�on Device rebate payments totaling more than 5600 per calendar ye2r, and e�ill <br />report the same paymeNs fo the Internai Revenue Service. <br />II accept the payment of the Backwater Prevention Device rebale from the City of [verett pendmp <br />,�pproval oi Ihe completed Backwater Yrevention Dewce rehate packaye by the Cily of Everelt <br />I <br />I/ p ���( /1 <br />Il�� i.rL--- --�LL.=-`-- <br />Signature of Contractor <br />���� <br />Date <br />