1611 E MARINE VIEW DR 2022-05-02

�, Contractor Section: i ' -- ----- ---------- — �pz_-i g --� i 3 � ��,�1�,� �r C c�c= � � 3 � - y 3-� � Vendor Name/ Business Name/ UBI Number � �'1�,411�1�'oi/�Li . State of Washington Contractor License NumbF:r. I a�i I U�S-Iv-rc�rv��_�=v.e,�e1� v ea. `i�0 8 , Vendor Mailing Address City State Zip 4Z5-�I��r- blZ3 iq-,4Plvn, hin�LL�34� __�'jmr�nl .� � Phone Email I I I � , I, the Vendor, ag , >io receive the Backwaler Prevention Device rebate check directly for the I installation at the aL �e referenced property address. By agreeing to receive the rebate check � direcUy, I agree lo lhe following: I � I 1. The Backwater Prevention Device rebate amount will be deducted from ihe final invoice given to the property owner for the installation al lhe property address referenced above, if the total cost of the instaliation is greater ihan ihe rebate. � 2. I, the Vendor, am a Washington State licensed contraclor. � 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater Prevention Device rebate payments totaling more than $600 per calendar year, and will ' report Ihe same payments to the Internal Revenue Service. � --- i ' I accept the payment of the Backwaler Prevention Device rebale from the City of Everelt pending � approval of the completed Backwater Prevention Device rebale package by the Cily of Everett � � i I � �- � - /S � Signature oi Contractor Date i � i �