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; <br /> � <br /> i <br /> , <br /> ; <br /> i <br /> Contractor Section: 1 <br /> _ -- ---t � <br /> �a r" J� �" �L�F'_—..' � 'L � �G�����?.3 f { <br /> �� � <br /> Vendor Name 1 Busine�s Name! UBI Number i <br /> /� ; <br /> - r �_I�-.Gs�/—�--"•�� i <br /> I <br /> State of Washington Contractor License Number. ; <br /> ��� L[a. r �i��1 f� P.,— --���''-c£�:7�����• � �— . <br /> Vendor Mailiny Address Ciry State ZiP <br /> ai��1��`7r��� C�tti2r.��.Ci_c_e:_•��,� �'�.-���'�'-a-�— ; <br /> Phone Email ; <br /> i <br /> I, the Vendor, a9ree to receive the Backwater Prevention Device rebate check directly for the � <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following' <br /> 1. The Backwater Prevention Device rebate amount will be deducted irom the final invoice : <br /> given to lhe property owner(or the installation at the property address referenced above, if ; <br /> the total cost of the installalion is greater than the rebate. � <br /> 2. I, the Vendor, am a Washington State licensed conlractor. ; <br /> 3. The City of Everelt will send a Federal Form 1099 MISC to me, lhe Vendor, for Backwater � <br /> !'�revention Device rebafe payments totaling more than $600 per calendar year, and will � <br /> reporl the same payments to the Inlernai Revenue Service. <br /> --�— i <br /> I accept lhe payment of the Backwater Prevention Device rebate from the City of Everett pending � <br /> approval of the compieted Backwater Prevention Device rebate package by the City of Everelt , <br /> i <br /> � ' O� c�— �V c'1� yJ ' <br /> Signature of Contracror Uate <br /> - i <br /> ---- i <br /> i <br /> i <br /> i <br /> , <br />