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Coniractor Section: <br /> �'����.;-��25��_��..���� _ �3 -��s, � I�__ <br /> Ve�ndor Name I Business Name 1 UBI Number <br /> ', h�solss S'�� �� _ -- ; <br /> '� State of Washington ��tractor License Number. i <br /> �;;3 ��6a G �, S.G��- �'r�,��5 U��+ �d�� 6 <br /> Vendor Mailing Address City State Zip <br /> � ,�C��6.���1�13 ��.�ir;P�S��µ�u:�clSe�?�2r�GMu'� � ,��,,� <br /> Phone Emaii ' <br /> I, the Vendor, agree.lo receive '.he Backa�2ler Prevenlion Device rebate check direcUy(or lhe <br /> inslallalion al lhe abo've re(erenced property address. By agreeir.g to receive lhe rebale check <br /> direr,lly, I agree to lhe following: <br /> 1 The �7acka�ater Prevention Device rebate amount will be deducled from the final invoice <br /> yiven lo the property owner(or lhe installalion at the property address referenced above, if <br /> thc lolal cosl of lhe installation is greater ihan lhe rebale. <br /> 2. I, the Vendor, am a Washingtc�n State licensed conlractor. <br /> 3. i he City c; Everett vnll send a Federal Form 1099 MISC to me, the Vendor, for Bar.kwater <br /> Prevenlion Device rebate payments totaling more than 5G00 per calendar year, and vrill <br /> report th�same payments to f`�e Intemal Revenue Service. <br /> --— ---- — - --- I <br /> I acr.ept the payment of the Backwater Prevention Device rebale from fne City of Everett pending <br /> ;�pproval of the crnnpleted Backwafer Prevention Dewce rebale packaye by the City of Everetl <br /> �`,� ������ ' �_ _ �-� - aG� � <br /> , <br /> SlgnaWM�. of Contraclo� Dale <br /> � -- -- J <br /> .��- - -- --- - <br />