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� -�- � _ _.-- - - ..__._--.-_-- _ -----�--,--�_ __.. <br /> �� •.. . . . :. <br /> �- • _ . . <br /> : ;; : , . <br /> �. �• . ... , . <br /> �� • , <br /> ;` <br /> ; <br /> . <br /> � • Contractor Section: J <br /> � <br /> ' ��/�� � <br /> j • -- - ��� � <br /> . Vendot Nam Business Nam UBI Number —�z/G, -�,2 � <br /> � ✓�'/, "' /G_ST.C� �.,e� �L� �C�T/'�G��1�..� I <br /> L <br /> ; - __._ � <br /> , State Washington Con ctor license N mt�r: i <br /> ; ` �.—�- T �� %� - ?,� � f <br /> � ,V�p orMailin�• dress� CIq Slat Zip � <br /> ? �;�� .L�� I 3 � ���'/ e� L' � f'2.7� , <br /> , � P oi�— ��L�~ �J�F-�Y� mail �#7� w . -�� Ll�//� � � <br /> - �� <br /> i <br /> 1, thn Vendor, agree to recelve the Beckwater Preven0on pevice rebate check direcUy for t �^A <br /> inslalla6on al the above reterenced propedy address. By agreeing {o rec9rve the rebate Chesk � <br /> directly, I agreo to tho following: i <br /> I �� �1. The Backwaler Prevention Device rebate amount will be deducted(rom ihe final involce <br /> ! given ro lho piopeny ownar for the ins�alla6on at tho property address referenced above, If <br /> ithe rotal wst of Ihe installatlon Is grealer than lhe rebate. <br /> � 2, I, the Vendor, am a Washington Stale licensed contractoc � <br /> ' 3, The Cily of Everett will send a Federal Fonn 1089 MISC to me, lhe Vendor, for BaCkwater <br /> ' Prevenlion Device rebate peymenls totaling more then 5600 per calendar year, end wiil ! <br /> rcpart tho samc poyments to Ihe Intcmnl Revanue Service. 1 <br /> iI . � <br /> -- ---- � <br /> � I accept the payment of the Backwater Prevantlon Devlce reb2te rram Iha City of Everalt pending ' <br /> , opproval of the completed Backwaler Prevenlion Dev�ce rebate packogo by the City ol Everetl <br /> I � / . <br /> � � . �, �,l'� ' 1� ' _.`'$� <br /> ! <br /> ; ignet��re oi Contrac r Oato • <br /> i , -- 'I <br /> �.;. . •f <br /> ;- � . � <br /> ;,;'� : ; . . . •� <br /> I , <br /> � � � . <br /> � ., ,•.: . . , � , <br /> . . ;_ <br /> . <br /> .. ,.__ . . _. .._. _ . . _ _ _... .. -- - -...---__.._..__. ._ ._ _ .:,.�.- -- ---_�_-- -,.-- - � ----�� <br />