Laserfiche WebLink
Contractor Section: <br />/j � <br />/% i� �U�I,/. /1i h L /liC� 2J � �— (i�� � " CJ.S �j� <br />Vendor Name ! Business ��ame I UBI Number <br />� i'L/ _L f�' �5-1 — — — <br />S,ate of VJashington Contractor License Number: <br />S`1G7 7/s ~/4V� NL M!�12 y.S ils'll� W� __ ��cJ <br />Vendor <<4ailing Address City Slatc� Zip <br />(_�l � S) ��s7 "1�c�7 <br />Phone ' Email <br />I, the Vendor, agree to rec�ive tl�e 8ack�vater Pr2v_ntion Device rebate chec; directly for the <br />insiallation at �h� aoo��e raferenc>d propery address. By aareaing to rec=_ive the rebate check <br />direcUy, I agrae to the follorring: <br />1 The Back��later Prevention Devic= rebate amount will be deducted from tne finzl invoice <br />aiven to the property o�vner for the installation at the property address referenc�d atove, If <br />the totai cost or the instaltatlon Is oreater than the rebate. <br />?. I, the Venoor, am a Washington State licensed contraclor. <br />Tne City of Evereit �vill send a Federal Form i099 N11SC to me, lhe Vendor, for Backv✓atcr <br />Prevention Device rehale payments btaling more than 5600 oer catendar year, and �vili <br />report the same paymenls to the Internal Revenue Service. <br />I accaot the payment or the Backwat2r Prevenlion Device rebale from thc� Cily oi Everett pendinc� <br />approval of the completad Backwaler PrevenUon Device rebate package by the City of Everett <br />. � �- r2-�;� <br />Signature of Co�tractor ___ Date <br />