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i <br /> ; <br /> � <br /> � <br /> I <br /> Contractor Section: i <br /> � <br /> oz_ . . 3 i <br /> ' ,r. '-rr {'N ��l�u!'�(__� '� /�li�n2 h//�'�� 9/. � i �3 i. ��3 7 I <br /> endor Name/Business Name/ UBI Number i <br /> I <br /> f'�/� l✓l ',�= G!/l i�� i <br /> State of Washington Contractor License Number: � <br /> I <br /> ��(l Ul Stz�6'�Cin�t 1��=- ��-evr��" C,c3� `���'L ' <br /> Vendor Mailing Address Cih� State Zip <br /> i���J--il�i -o�z3 �r�-Pl�,�i�„2 � r�L�- ��' 1 <br /> __._� Y . �' 7m9�( Ccn� I <br /> Phone Emaii <br /> I <br /> � <br /> , <br /> i <br /> I, the Vendor, agree to receive lhe Backwater Prevention Device rebate check dlrectly for ihe � <br /> (nslallation at the above re(erenced property address.By agreeing to rece(ve the rebate check <br /> directly, I agree to the following: j <br /> I <br /> I <br /> 1. The Backtvater Prevention Device rebate amount will be deducted from the final Invoice j <br /> given to the property owner for the Installation at the properiy address reterenced above, if � <br /> the total cost of the inslallalion is greater than the rebate. � <br /> 2. I, the Vendor, am a Washinylon Slate licensed wntractor. ; <br /> 3. The Ciry of Everett will send a Federal Form 1059 MISC to me, the Vendor, for Baclnvater j <br /> — Prevenlion Device rebate payments tota!ing moro than$600 per calendar year, and will � <br /> report the same paymonts to the Intemal Revenue Service. <br /> I accepl the payment of the Baclavater Prevention Device rebate irom lhe City of EvereR pending ' <br /> approval of the completerl Rackv✓ater Prevenlion Device rebale package by the City oF Everett 3 <br /> i <br /> i <br /> c � I <br /> -�'`�- /�- I <br /> Signature of Conlraclor Date ; <br /> i <br /> — — -- ! <br /> , <br /> i <br /> i <br /> i <br /> i <br /> � <br /> 1 <br /> � <br />