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Contractor Section: <br /> /�r�,LLC�J�GuM� L�lv (�� —�i/ � - vSSl <br /> Vendor Name!Business Name / UBI Number <br /> �'�LL��S�G,is-� <br /> State of VVashirgton Contractor License Number: <br /> ' s�1� y��Ni� ���i° s✓r ,��,v� 9,�s��U <br /> Vendor Mailing Address City State Zip <br /> C��zs) ��� �-i.��� <br /> Phone Email <br /> 1 <br /> I, the Va��dor, agree to receive the 8ack�vater Prevention Device rebate check direclly for lhe <br /> installation at the above referenced property address. 3y agreeing to receive the rebate check <br /> directly, I agree to the follo�^;ing: <br /> 1. The Baclnvater Prevention Device rebate amount will be deducted from the final Invoice <br /> gi��en to the property owner for lhe instaltation at the property address referenced above, If <br /> the total cost of the installation Is greater than the rebate. <br /> Z, I, the Vendor, am a N�ashin9ton State licensed contrector. <br /> 3. The Ciry ot Everett will send a Federal Form 1099 MISC lo me, the Vendor, for Backivater <br /> Prevention Device rebate payments totaling more than SG00 per czl?ndar year, and e�ill <br /> report t!�e same payments to thz Internal Revenue Service. <br /> r �I accepl Ihe payment of the Backv,�ater PreveNion Devica rebate from Ih�Ciry of Everelt pending <br /> approval of the completed Backwaler Pre��ention Device rebale package by the City o!Everelt <br /> I <br /> � <br /> G �U _/S <br /> Signalure of Contractor __ , Da�e <br />