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Contractar Section: <br /> —",� <br /> '� j�� � � zvt ��� �� bo� �s- Il� �I <br /> �_� <br /> Vendor Name/ Business Name/i1Bl Number i <br /> - So�SS���� - _ _ — - � <br /> State uf Washinylon raclor License Number. <br /> �_ ���'�� ��-45� �C�i'�i_o�S �/� �1��2C <br /> Vendor Mailing Address Cily Stale Zip <br /> �� - �I�.S- �-[I�� �����-�-c5-�� a��S��� �,�; I, c��� <br /> Phone Email <br /> i <br /> I, the Vendor, agree lo receive the 8ackwater Prevention Device rebate check direcUy for the <br /> installalion at the above !eferenced property address. By agreeing to receive fhe rebate check <br /> directly, I agree lo the following� <br /> 1. The Dachwater Prevention Device rebale amount will be deducled from the final invoice <br /> given lo the property owner ior thr installation al the property address referenced above, if <br /> (I�e lolal cost of the installation is grealer lhan lhe rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The Ciry o(EvereU will send a Federal Form 1099 MISC to rne, lhe Vendor, for Backwater <br /> Prevention Device rebale payments lotaling more than 5600 per calendar year, and�viil <br /> report lhe same payments to the inlemal keven�e Service. <br /> I accep[lhe payment of the Backwater Provonlion Device rebate from the Cdy of Everett pending <br /> approval of lhe completed Backwaler Prevenlion Device rebate pacY,ago by lhe City of Everetl <br /> � /� i� ` <br /> �'�5���,�- 2-��-�-0�S <br /> I <br /> � Sig alure of Conlraclor — — Date — _— I <br /> i J <br />;� <br />