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Contractor Section: <br /> i'��-�� �'�h;,��_�— �k'�_�_��-r� a <br /> Vendor Name/Businr.ss ��'ame /UBI Number <br /> / `" I,U-C� f�r.� �� �� — <br /> State of Washington Contractor License Number: <br /> � �7� 5. y� sh�y � �.�ee��unSl� +-✓f"}' �/,�'jdiU <br /> Vendor Mailing Address ' Cily State Zip <br /> `-/,� S 7�c �S��a "�ru�'�l i-r;;�a, r�U.,1�,�. . c:�,._ <br /> Phone Email <br /> I, the Vendor, agree to receive 1he Backwaler PreventiomDevice rebale check directly for the <br /> installation al the above referencedproperty address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> t. The Backwaler Prevention Device rebate amount will be deducted from lhe final invoice <br /> given lo the property owner for the installalion al lhe property address re(erenced above, if <br /> lhe lolal cosl of the installalion is greater lhan the rebale. <br /> 2. I, lhe Vendor, am a Washington State licensed contractor. <br /> 3. The Cily o(Everell will send a Fedcral Form 1099 MISC lo me, the Vendor, for Backwater <br /> Prevention Device rebale paymenls totaling more than 5600 per calendar year, and will <br /> report lhe same payments to the Inlernal Revenue Service. <br /> I accepl tf�e payment of the Backwater Prevention Device iebate from the Cily of Everelt pending <br /> approval of the compleled Backvdater Prevention Device rebate package by the City o(Everell <br /> �� `��`'�__ � - � �- ( S <br /> T <br /> SignaWre of Contractor Date <br />