Laserfiche WebLink
Contractor Section: <br />�i��J�—=.�,� `" ci.e. �,f� cc�('l' LLG ��:'� _ 3�L�t�3 <br />�- -- -1�`�.]�- � <br />Vendor Name! Busine s Name! UBI Number <br />����Z����� � <br />State of Washington Gontractor License Number: <br />�_(d�� �-4L <br />Vendor Mailing Address <br />City State Z�P <br />-�:f0•"�L�g� C���i� r; ct�.-L?��2 ��/� �����f�� <br />Phore <br />Email <br />L the Vendor, agree to receive the Backwaler Prevention Device rebate check directry for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />iiirec:ly, I agree to lhe follo�viny� <br />t The Backwater Prevention Device rebate arnount will be deducted frorn the final invoice <br />given to the property owner for the installatian et the property address refarenced above, if <br />the total cost of the installation is grealer than the rahate <br />�. I, the Vendor, am a Washing[on State licensed contraclor. <br />3. The City of Everett iviil send a�ederal Form 1099 MISC to me, the Vendor, ior Backwater <br />Prevention Device rebaie payments totafing more than 5600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accepl the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backv�ater Prevention Device rebate par.kage hy the City of Everett <br />� ----�--�-.r_�-' �_ <br />SignaWre of ConUar,tor <br />_ � � ��_ <br />Date <br />�— --- --- <br />.�,.-.�- _..— <br />