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Contractor 3ecfion: <br />��11-r_,�cc�--�z"r�'� .�ir.1c'—.`"r_,�N� LLC=-G���4-�' ::-�3S <br />Nendor Name I Business Mame J UE3i Number <br />� <br />A_r�t ru- ���.�1�.� --- - - ' <br />State of Nlashinglon Contraclor License Number: � <br />_ar�z�; �<<r.���--�Q�' ��n_� I.t?fl Gj.��.�.:3 <br />Vendor �Jailino Address City State Zip <br />` �'� t _ i � CCc: �� �� � ' • - � '� Ci'r'] <br />_�LirL'�IL'_�C:�---_ _%._�cl �- _Ct�7"r'C��� -f.�f-1=iS—t- I , <br />Phone Email <br />I, Rie Vendor, agree ro receive Ihe Daclnvater Prevenlion Device rebate check direclly for the <br />irsiailatinn at ihe a6nve referenced property address. 8y agreeing to receive the rebate chec'; <br />ri�,rectly, I agree to the tallo�.vmg: � <br />�. The Backuater Prevention Deqice rebate amount vnll be dedur.ted from the finai invoice <br />given !o the propeny ovmer for, Ihe instailation al Ihe property address refe�enced above, if <br />thw totil cust nf thc in�tall�lion is grea�er than Ihe rebale. <br />?. I, the Vendor, am .� Nlashingtnn SWIe licensed centmc�or. <br />3. The City Of [vereU will send a Federal Form 1099 N,ISC tn me, the Vendor, for Backwat.�r <br />Prevenlion Uevice rebale payments totaling more than S600 per calendar year, :ind �•lill <br />rr.port the sarnr paymr.nls to the Internal Revenuc Scrvice. <br />I� accepl the payment of the Bach�:eler Prevenlion Uevice rebate irom the Ciry ot Ever�tt pending <br />approval o( the completed Bactavater Prevention t]evicr. rebale package hy Ihe Cny of Fverelt <br />!� ° �--�0 -- -- - - -- --�-a-l�--`'=- <br />Signature of Contractor Dale <br />