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i <br /> Contractor Section: � <br /> i <br /> (� --- -- -- < < , , , r,�� �c% �•�'�� � <br /> I �!'��l��'1�1'�-�—.`�{�cC�-.5r_ �'__,.���—�1_�L-LL fa-•_���� I <br /> i <br /> Vendor Name 1 Busine s Name/ U81 �lumbcr <br /> I i <br /> ' �LC1xR_�',L`�`}.�'-�—I�.� - ---- � <br /> Slale of 1Nashington Contr2ctor License Number. � <br /> �.1✓��•(��_{,��__�'�a�[%� i <br /> ' �_��J�i L�l C�I`�_Q-(�•-- � <br /> Vendor Mailing Address City Slate Z�P ; <br /> ; <br /> l o�c-��-��t�_g'�__—__C��r�� ', 's�c.:���� <i ' t_��Qosc��_ : <br /> ', Phone Email <br /> � <br /> ; <br /> � _ — — <br /> I, the Vendor, agree lo receive the Dack�valer Prevention Device rebate check directiy for Ihe , <br /> installalion at the above referenced vroperty address. B��agreeing fo receive the rebate check <br /> directly, t agree to the followirg: ' <br /> 1. Tha Backwater Prevention Device rebale amount�vill be deducted from ihe final invoice , <br /> given lo the property owner for the inslallalion at the property address referenced above, if <br /> the lotal cosl of the installalion is greater than the rebate <br /> 2 I, tho Vendor, am a�Vashington State licensed contraclor. � <br /> 3. The City of Gverett e�ill send a 1=ederal Form 1099 �v11SC to me, ihe Vendor, far Back�vater <br /> Prevention Device rehate payments tolaling more than 5600 per calendar year, and will � <br /> repoil the same paymenls lo the INernal Revenue Sen�ica ; <br /> 1 accept the p��Yment of lhe f3ackwater Prevention Device rebale (rom lhe L'ily of Everetl pendiny <br /> appwval of Ihe complefed Backwater Prevention Device rebale packagr hy lhe City ot L=verell � <br /> � <br /> 3 � <br /> C�..�:.{�_ � �-.�_.� __ �- -1�-�— . <br /> Date ; <br /> Signature of Conirac[or � <br /> i <br /> J <br /> I <br /> � <br /> I <br />