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Contractor Section: <br /> ' ���9"�'iCst�-__`��:�. _c.0`-�_j�.�__����-c�'C_���-�-C- _ ;c''�L��.s�� <br /> Vendor Name ! Qusine.§s Name 1 Uf31 Number I <br /> �!-l_1_��.z`�-�-��-I KI- - - - -- - <br /> IS�ate of �R�ashinglon Contractor License Nwnher: , <br /> �� �1���- -l-�a r �►,�--DP_��----��'�-c_e_tf' �c7�_ �'��_c.� I <br /> '� Vendor P:lailing Address Ciry State Zip � <br /> I <br /> �L�4�-.�L�1Q�._L'�Y_k��.C_i (:i'_ _:��1�1 ��i��(���o��. �r1i� -- ' <br /> Phone Email � <br /> � <br /> ---- --_ ' <br /> I, tf�e Vendor, aaree to receive the F3ackv�aler Prevention Device rebate cherk direcliy for the <br /> �n;tallation at tne above referenr.ed property address. By agreeing to receive the rebate check <br /> d:rcctly, I agree to the following <br /> 1. The Backwaler Prevention Device rebate amount v�iil be deducted from the fnal im�oice <br /> gr;en to the property owncr for Ihe installation at ihe property address refzrenced above, �` <br /> �ha total cost of ihe installa�ion is grrater Ihan the rebate. <br /> � I, lhe Vendor, am a Washinglan Staie licensed contraclor. <br /> 3 The City of Everett tivill send a Federal Form 1099 MISC lo me, the Vr,ndor, (or Bar,k�oater <br /> Pravention Device rebate payments totaling more than 5ED0 per calendar year, anri v�ili <br /> report the same payments to the Intcrnal Revenue Sen�ir.e <br /> -- - _ _ ---- --- - ._— ._ <br /> - - - <br /> �� I :�ccept !he payrnent of Ihe Back�•dater Prevention Device rebate fiom the �ity ui Eve:eit pending i, <br /> approval ot lhe completed Bar,kv�ater Prevenlion Device rebale package by the Gty o(Everelt <br /> i <br /> ) i <br /> II `�_ _. . �t.--�-��:-Sr-i,_-------- — - � �`�-" f�-- - -- <br /> Signature of Coniractoi Dale <br /> �-- — — --- --- ---— - — -- -- - —- <br />