Laserfiche WebLink
Contractor Section: <br />A:�G�� t�i� <br />I Vendor Name I B <br />Name / UBI Number <br />l��J!_�G %Z'�3 G% — <br />State of VVashington Conlractor License Numbec <br />S ��G� ��s� `����P — -- �c.i� sv.i�� - —4 � —����o --- <br />Vendor Malhng Address City State Zip <br />3<j? —/.so <br />Phone <br />Email <br />1, Qie Vendor, agree to receive the Backv�ater Prevention Device rebate check dvectly for the <br />installat�on at the above referenced property address. By agreeing lo receive the rebate cnec+ <br />d�red�y, I agree to ihe follo���ing: <br />1 <br />Z <br />3 <br />The Backwater Prevention Device rebate amount will be deducfed from the final invoice <br />given to Ihe property ovmer for the instaliation at the property address referenced above, if <br />the total cost of the installallon is greater than the rebate. <br />I, the Vendor, am a Washmgton State licen,ed conlractor. <br />ihe C�ty of Everett wdl send a Federal Form 1099 MISC to me. Uic Vendor, for 8ackwater <br />Prevention Dewce rebale payments totaling more than $600 per calendar year, and ;�ili <br />report the same paymenls lo Ihe Internal Revenue Service <br />� t accepl lhe payment of the Backv.�ater PrevenUon Device rebate tror:i the Cny of Everetl pend�ng <br />' approval of the completed E3ack�e�ater Prevention Device rebate package by the Cily of FvereU � <br />i <br />i �i/ ~ <br />� Signaturc of Conlraclor <br />? ���/,S� <br />Date <br />i � <br />— — ---� <br />