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Contractor 5ection: <br /> Sewer �r � e�;1,t L.�-C � c� 0 2 � 35 78� <br /> Verdor Name/ Business Name/ UBI umber <br /> SeWer- -� l_�1 lP v� S <br /> State of Washinaton Contractor License Number: <br /> �I �c� �x �-I-15 � nn� �_� �UA- �$'a�l(� <br /> Venc �r Mailing Address City State Zip <br /> ; -2Dlo 8�0 —i4� 8 '��,+IiP�Se,w�r���n��r,m <br /> rhone Email I <br /> i <br /> J <br /> I, the Vendor, agree to receive the Back�vater Prevention Device rebate check directty for the <br /> installation at ihe above referenced prop=rty address. By aoreeino to receive the rebate check <br /> directiy, I aaree to ihe fo!lowing: <br /> 1. The Back�valer Prevention �evlce rebate amount e�ill be deducled from the final Invoic= <br /> given to the property owner tor(he inslaltation at the propeRy address referenced above, �t <br /> lhe lotal cost of lhe installation is greater than the rebale. <br /> 2. I,the Vendor, am a\Nashinglon Stale lic?nsed conlractor. <br /> 3. The City of Everett�vili send a Federal Form 1099 MISC to me, lhe Vendor, for 8ackv�ate� <br /> Prevenlion �evice reqate paymenls fotaling more than 560� per calendar year, and�vill <br /> report tha same payments to Ihe Internal Rever,_a Servico. <br /> I a�cept lh� payment of the f3ackv:aler Prevenlion pevice rebale from the Ciry o(Everett pending <br /> approval ot the completed Backe�ater Prevenlion Device rebate package by Ute City of Fverett <br /> ��� ����� <br /> Signature of Coniractor Dale <br />