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Contractor Section: <br /> - -- --- - --�c�z=-����-?- 3 <br /> , <br /> �,v r. ' f� �12��2 ;./�l'�1�—���h�h/n�—' C 9/.i ��3 ��3 7 <br /> �endor Name(Business Name/ UBI Number " <br /> _�9-I��/� �✓l� Q�//�!� ------ <br /> State of Washington Contraclor License Number: <br /> �G!/ !/lSm��irlrt l9�2= t�.evu`� G�� �;YZ�z3 <br /> Vendor Maiiing Address City State Zip <br /> iIZJ�--�If�� -G�73 �4i9-P%,�-,��„��; i.LL ,��y7���im�il• Cm�� <br /> Phone Email <br /> I, the Vendor, egree to receive the Back�vater Prevention Device rebate check direclty for the <br /> installation at the a5ove referenced property addresa.By agreeing to receive the rebate check <br /> directly, I agree to ihe follor�ing: <br /> 1. The BacMt-ater Prevenlion Device rebale amount�vill be deducted frorn Ihe final invoice <br /> given to the property owner for ihe installation at the property address referenced above, If <br /> Ihe total cosl of the instailation is greater lhan the rebate. <br /> 2. I, the Vendor,am a Washington State licensed contracloc � <br /> 3 The City of Everett�:�ill send a Federal Fomi 1099 �dISC to me,the Vendor, for Back�•�aler � <br /> Prevenlion Device rebale payments tolaling more than $600 per calendar year,and will <br /> repoA the same paymenls to Ihe Internal Revenue Service. <br /> I accept the payment of Ihe Oackwater Prevention Device rebate from ihe City of Everetl pending <br /> approval of lhe completed Dac'Kwater Prevenlion Device rebate packaye by Ihe Ciry of[verett <br /> ���1' �_ -f��a�/S <br /> Signature of Contractor Date <br />