Laserfiche WebLink
Contractor Section: <br /> /``l oe.�� I�l� .�ti �i��— (� (� ol G�` � �-- <br /> Vendor Name/Business Name UBV I Number <br /> Moen ��P �` 88 3.TU _ , <br /> State of Washington Contractor License Number: <br /> � �s � S �� � u st s�= s,��ti����sr� W� ��a�o <br /> Vendor Mailing Address Cily State Zip <br /> �I.2S 76D k3 �U '(,�c•.� � nv�l�,.�-,�li�y , cu,� <br /> Phone Email �— <br /> I, the Ve�dor, agree to receive the Backwater Prevention Device rebate check direcUy for the <br /> inslallation at Ihe above referenced properly address. By agreeing to receive the rebate check <br /> directly, I ayree to lhe following: <br /> 1. The Backwater Prevention Device r�bate amount will.be deducted from the final invoice <br /> given lo lhe property owner for the installation at Ihe p�operty address referenced above, it <br /> the total cost of llie instalialion is grealer than lhe rebate. <br /> 2. 1, ihe Vendor, am a Washington State licensed contractor. <br /> 3. The City oF Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebale paymenis totaling more than $600 per calendar year, and will <br /> reporl the same payments lo Ihe Inlemal Revenue Service. <br /> I accept the payment of the F3ackwaler Prevention Device rebate irom the City of FvereU pending <br /> ��PProval o(the completed [3ackwater Prevention Device rebate p�r.ka�e by Ihe City o(Fvere�l <br /> °��� � �y2�--- I �'.- 1 7-I u <br /> Signaturc of Conlraclor Date <br />