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Contractor Section: <br /> — - —-- -- -- ------ <br /> � <br /> ���=t'-'ic:t.��--���-�c.�-�-i_c����jt:ti�'..(_�,_L_l�%--��c}'� :32�t�':'s I <br /> Jendor Name I 6usine s Name I UBI Number <br /> I � � � �/ <br /> I ��-��Z-�_•�-,�—� 'lL'-i--11-�-- --- -- -- -- <br /> State oi Washington Contraclor License Number: <br /> � -o�-�v��_—L�VL�j�—�_Qa__�t✓_C=_C�'�—I��-��'_5�.��'� <br /> I Vendor ivtailing Address Ciry State Zip <br /> �, <br /> aa4�-,�to��4�—__C_"�scis�e�� �J� �o�s�t2'1_ <br /> Phone Email <br /> i— --------- ---- <br /> I, ihe Vendor, agree to receive the Backelater Prevention Device reba;e check directly for Ihe <br /> irstallation at the above reterenced property address. By agreeing to receive the rebate cher.k <br /> r'irectly, I agree to the follov�ing <br /> +, 'The Backwater Prevention Device reC�te amount�vill be dedur.teJ Irom the final invoice <br /> given to fhe property o�.vner for the inslallation at Ihe properiy address referenced ahovc if <br /> Ihe total cost of lhe installation is greater than thc rebatz <br /> 2 I, ;he Vendor, am a Washington State licensed contraclor. <br /> 3. 1'ite City of[verett e�ill send a Federal form 1099 ti11SC to me, the Vendoi, for B�ck�•:,iler <br /> Prevention Device reb�te paYments totaling more than $600 per calendar year, and�^.ill <br /> report thc same payments to the Internal Revenue Seroice. <br /> � I :�ccept Ihe p��Yment of the Backwater Prevention Device rebate (rom Ihe C�ry of Everelt pendmy ;' <br /> approval of the completed Backwaler PrevenUon Device rebate par.kage by the City o(Everett I <br /> ' �l <br /> � `�_—��� -- --1�a� � <br /> Signalure of Conlractor ���P <br /> ' - - - - - - -- - _ - -I <br /> i— - — - — ---- - ---- - — <br />