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�ontractor'SEct.ion: <br />�,��5���,`I�-��c�C��Na��d ��i^'ej� ( <br />Vendor. Nama ! Businas� iVame / UBI Number <br />%�I�SOL�� �'�-1. \S <br />State c` VVashington Conlractor <br />���3 a3��� -5� <br />Vendor Mailing Address <br />�PG - �(GS ��-- <br />Phone <br />� - �,8 <br />se Nurrber: <br />_ � 0't�(� <br />City <br />��`�i�i�Y�'((/L1 <br />Email ' <br />_ If f <br />�,�;�1- �go�� <br />State Zip <br />e� n �Uai �, Cv;�l <br />I, the Vendor, agree to receive the Backvdater Prevention Device rebate check directly for the <br />installatinn at the above referenced property address. By agreeing to receive the re6ate check <br />directly, I agree to the following: <br />t. The Backv�ater Prevention �evice reba[e amounl �vill.be deducled from the final invoice <br />given to ihe property.ovner for the installation at the property address referenced above, if <br />the total cost of tfie i�i=tallalicn is greater than the rebate. <br />2: I, the Vendor, am a W<shington Slate licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISGto me, lhe Vendor, for 8ackwa�er <br />Prevention Device rebale payments totaling more than 6600 per calendar year, and will <br />report the same paymenls to the Internal Revenue Service. <br />I accept the payment of the Backwater Preventinm0evice rebate from the City of Everett pending <br />approval,of the cnmpleted 8ackwater Prevention Device rebate packa�e by Ihe Ciry of Everelt <br />� , ��� �-1- a�ls <br />ignal i� �e of Conlractor Dale <br />— " ,�,;e�;.� r+ :. �:'' u rr i6:,..iL6N _., . � ,-'<� <br />nJ � �'.^, _'�..-+�"u c..�'Tf��i'r�.� +MS�a A�"t'3�frmr«..�iL..::u..i ��. ���'��/r 'Wt�T� ,�y„'�. •.�.. <br />