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1 <br /> I <br /> i I <br /> I <br /> I <br /> � <br /> Contractor Section: ' <br /> -- -- --- ------� i <br /> I �CJ'S PLUWIBING&�ERVIC[�LC/602 950 it7 � <br /> — { <br /> Vendor Name/ Business Name/ UBI Number j <br /> ! <br /> C,1SPI.P59150D i j <br /> i <br /> i <br /> State of Washington Contracfor License Number. <br /> i <br /> 552821BTH AVE NE GRAll1T[FA�LS WA 98252 ( <br /> i <br /> Vandor Mailing Address City Slate Zip ' <br /> I <br /> 360-691-5159 C!SPLUF+IBINGQ615N.GOM ' <br /> - i <br /> � Phone Emai � <br /> �I <br /> L�— - <br /> I, the Vendor, agree to receive the Back�vater Prevention Device rebate check directry for t..a � <br /> installalion at the above reterenced property address. By agreeing to receive the rebate check i <br /> dlrectly, I agree to the following. � <br /> 1. The 3ackwater Prevention Device rebate amount will be deducted irom the final invoice ` <br /> given to the property o�vner for the installation at the property address referenced above, if � <br /> Ihe total cost of the inst211alion is greater than the rebate. � <br /> Z. I, the Vendor, am a Washington State licensed contractoc ' <br /> i <br /> 3. The City of Everell�vill send a Federal Form 1099 MISC to me, the Vendor, (or Back�vater ! <br /> Prevention Device rehate payments tot�ling more than 5600 per calendar year, and will ; <br /> report the same payments lo the Interna� Revenue Service. � <br /> i <br /> ._ - -- ---i j <br /> I accepl Ihe paymenl of the Backwater Preve�ition Device rebale from the City of Everett pending ' <br /> approval ot the compleled [3ackwater Prevention Device rehate package by ihe Ciry o( Everelt . <br /> i <br /> I <br /> � � �� � �� � �� � <br /> � <br /> Signature o( Contractor Date ` <br /> � <br /> � <br />