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Contractor Section: <br />MDen (�I�.,.�-,�i�r <br />Vendor Name / Business Name I UBI Number <br />M�t�PP*-�553� 0 <br />State of Washington ConVactor License Number. <br />��5�5 N�� sr SH <br />Vendor Mailing Address <br />�-f� S 7�U �6�3�D <br />phone <br />(�DoZ G8� yy� <br />SnJl�or.� S� �t/r�r" <br />Cily State <br />I�G'n�'a Mven�7�UmLr1'n� <br />d <br />Email <br />Zip <br />LU h <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for lhe <br />installation at the above referenced property address. By agreeing lo receive Ihe rr.bate check <br />directly, I agree to the following: <br />1. ?he Backwater Prevention Device rebale amount will be deducled from the final invoice <br />given to ihe property owner for lhe installation al ihe property address referenced above, if <br />thc total cosl of lhe installalion is grealer than the rebate. <br />2. I, the Vendor, am a Washington Slale licensed conlraclor. <br />3. The City o( Everell will send a Fedcral Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments �o�aling more Ihan $600 per calendar year, and will <br />ieport the same paymenls lo lhc Inlemal Revenue Service. <br />I accept Ihe payment oCthe Backvocder Prevention Device rebale (rom �he City of Fverett pr.ndinr� <br />approval of ihe compleled Backwaler Prevention Device rebate packac�e by the Cily of Everetl <br />dc_,`� r� %�%��_ <br />Signature of ConUaclor <br />I .� - ( �— I �f <br />Dale <br />