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, <br /> ..�� . <br /> � <br /> i <br /> Contractor Section: <br /> CJ'S PLUM0ING 8 SERVIC[L�C/602�950 717 � <br /> Vendor Name/ Business Name I UBI Number - <br /> CJSPLPS9150D <br /> State of Washington Conlractor License Number: <br /> -� 5528 218TH AVE NE . GRANITF FALLS WA� � 98252 <br /> Vendor Mailing Address City State Zip <br /> 3fi0�fi91-5159 CJSPLUMBINGOlv1SN.COM <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced propeRy address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount wiil be deducted from the finai invoice <br /> given to the property owner for the installation at the property address�eferenced above, it <br /> the total cost of lhe installation is greater than the rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractor. • <br /> 3. The Ciry of Everetl svill send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate paymenls totaling more than �600 per calendar year, and will <br /> report the same payments to the Intemal Revenue Service. <br /> � I accept the payment of the Backwater Prevention Device rebate from ihe City of Fverett pending <br /> approval of the completed Backwater Prevention Device rebate package by the Ciry of Everett <br /> � I <br /> c � <br /> Signature of Co clor Da <br />