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. � <br /> I <br /> . ! <br /> � <br /> C:ontractor Section: � <br /> , <br /> — ' <br /> r-- " _ I <br /> I ���: �.C-��r_c�'.�`� 'i��'C, LLC, /�c�'��3�<i-�.3 j <br /> �:�rt.c�c � <br /> Ve.idor Name 1 Busine ��ame/UBI Number � <br /> � <br /> ' �.L1� `�-`5-5 ; <br /> �z_ �K-�------ ; <br /> St2te of Washington Coniractor License Number. i <br /> 1 <br /> ����o_ L�_C�.i���.--�WN f'��-.(,c��--�t"b'_�o5 � <br /> Vendor Mailing /lddress City State Z�P ; <br /> i <br /> �L�.�1��?Lg�_C��3�i�� �� ' r_����-c.�2-- �: <br /> Phone Email � <br /> _ � <br /> i <br /> I, the Vendor, agree to receive the Backwater Prevenfion Device rebate check directl�� for the � <br /> installalion at Ihe ahove re(erenced property address. By agreeing to receive the rebale check , <br /> direclly, I agree to the follouing: <br /> 1, The Back�vater Prevention Device rebale amount wiil be deducted from Ihe finai invoice <br /> i <br /> given to the property owner tor Uie installation at lhe property oddress reforenced above, if <br /> the tolal r.ost of the installation is c�reater than the rebate. <br /> 2. I, Ihc Vendor, am a Washington State licensed conlractor. <br /> t <br /> 3 The Cily of Everett�vill send a Federal Form 1099 MISC to me,the Vendor,for Bar.kwater � <br /> Prevention Device rebale paymenls tolaling more than 5600 per calendar year, and will � <br /> report the same payments lo Ihe Intemal Revenue Service. <br /> I accepl Ihe paYment of the Backwater Prevenlion Device rehate from the Cily of[veiett pending i <br /> approval o(the completed �ackwater Prevention Device rebate package t�y lhe City of Everelt <br /> i <br /> i <br /> .� � <br /> l�a�— ��r,�-'�=Gc ��-��-- 1 <br /> Signature of Coniractor Date ; <br /> , <br /> ------ — ------ ; <br /> --- � � <br /> � <br /> i <br /> � <br /> i <br />