Laserfiche WebLink
Contractor Section: <br />I�o //a �13! (a� <br />Vcndor Namc ! Business ame I UBI Number <br />(,lCw�.���G�f i _--- <br />State of Washington Contraclor Lir.ense Number: <br />S1p1 --71s--��� N� --�ai�SVi//G �L�_FS_�—� -- <br />Vendor Mailing Address City Staie Zip <br />��7 -/Sc7 <br />Phone Email <br />I, lhe Vendor, agree to receive the Backwater Prevention Device rebate check directly for lhe <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />direclly, I agree lo lhe following: <br />1. The Backwaler Preveniion Oevice rebate amount will be deducted from the tinal invoice <br />given to tho property o�vner for the insfallation at lhe property address re(erenced at�ovc, iF <br />lhe total cost oi the inslallation is greater than ihc rebale. <br />2. I, the Vendor, am a Washington State licensed conlractor. <br />3. The City of Fverett will send a Federal F�rm 1099 MISC to me, the Vendor, tor Backwaler <br />PrevenUon Device rebate payments lolaling more than 5600 per calendar year, and will <br />report the same pay .�ents lo the Internal Revenuo Service. <br />I accepl the payment of the Backvrater Prevention Device rebate irom Ihe Cily o! Everett pending <br />approval of lhe complzted Elackwater Prevention Device rebale package by IFe Cily of Everelt <br />of Gontractor <br />����/S' <br />Da�e <br />�— ------ - _ --- — --- -- - <br />