Laserfiche WebLink
Contractor Section: <br />��o//lJ 1�1u�—B%��_—.__1�'i� o� i �. <br />Vendor Namc I Business 1'�ame I UBI Number <br />l; �G��CG i�G� LJ -- -- <br />State o( Washinglon Coniraclor License Number: <br />S�/_✓'�—.7�Ls�.�'�G._��� �Gt�SYiI�G.—w�i' _l�-��?�--- <br />Vendor �vlailing Address • Cily State Zip <br />Phone <br />Email <br />1 <br />I, the Vendor, agree to rece�ve Ihe Backwater Prevention Device rebate check direclly for the <br />inslallation al the above referenced pioperly address. By agreeing to receive the rebate cneck <br />directly, I agree lo the tollor:ing: <br />1 <br />2. <br />3. <br />The Back�valer Prevenlion Dewce rebate amount v+ill be deducted from the final mvoice <br />given to the property olvner for lhe installat�on at the property address referenced above, i( <br />the lotai cost o( lhe installation is greater than Ihe rebate. <br />I, the Vendor, arn a Washington State licensed conlractor <br />The City of Everelt e�ill send a Federal Form 1099 MISC to me, the Vendor, for l3ackwater <br />Prevention Device reba�e payments �otaling more �han 5600 per calendar year, and evtll <br />report Ihe same payments to the Inlernal Revenue Service <br />u <br />fI accepl lhe paymenl of the Back�vater Prevention Device rebate frorn the Gty of Everett pending I <br />I approval of the comple�ed Backwater PreveNion Device rebate package by �he C�ty of Everell � <br />SignaWre of Contractor <br />2/�/�is <br />Date <br />