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� <br /> i <br /> ; <br /> ; <br /> Contractor Section: � <br /> � <br /> , <br /> ����r I I\. L-�--C �' ��� 3 5'� �(� i <br /> Vendor Name/Business Name/ U�I Number i <br /> � <br /> sewe,-�i-`�i U m� i <br /> State of Washington Contractor License Number: � <br /> ��_�_�,�X .�"� -- L�' ��?i��1,� G��' ��/� I�L'� � ; <br /> � <br /> Vendor Mailing Address Cily State Zip j <br /> �����' ���._ �-�_� b �U,��f'�`,f.W�r-���� jt'i�tC{ ���,Cbl�-� . <br /> Phone Email <br /> � <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check direclly for the <br /> installalion at tho above reforenced properly address. Oy agreeing to receive the rebate check � <br /> directly, I agree to the tollowing: � <br /> 1. The Backwaler Prevenlion Device rebate amount will be deducled from Ihe fnal invoice ' <br /> given to the property ownor for the installation at the property address referenced above, if <br /> lhe total cosl of the inslallalion is yreater than the reba(e. ' <br /> i <br /> 7_. I, Ihe Vendor, am a Washinglon State licensed contractor. `: <br /> 3. The City of Everett will send a Federai Form 1099 MISC lo me, the Vendor, for Backwater i <br /> Prevention Device rebate payments tolaling more than $600 per calendar year, and will <br /> report the same payments to the Inlemal Revenue Service. � <br /> I accept the paymenl of the 9ar,kwater Prevenlion Device rabale from ihe Cily of Everelt pending , <br /> approval of the completed Backwater Prevention Device rebale package by Ihe City of Everetl <br /> , <br /> � .� <br /> i <br /> _��-�%;�.� ����-L�-C�_ ' <br /> � <br /> Signature oi Contracror Date <br /> —------ --- _ - —_ - - ---— ---- _ _ i <br /> I <br /> � <br />