Laserfiche WebLink
Contractor Section: <br /> �'�c��s�;:��� �.� —?��. I I � <br /> Vendor Name/ Business Name/U81 Number <br /> bS'o ISS � �,�'�S <br /> State of�Vashington Contr�etor License Number: <br /> _ -��� a3��ks�.sw ����s w� q�a6_ <br /> Vendor Mailing Address City State Zip <br /> �viv� ��/�/ � `( � l� �VSC�����U�Fh[Ut��ctS2�- ��' '�.14,i I, f G�i� <br /> Phone Email �,� <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly(or ihe <br /> installalion at the above referenced•property address. By agreeirg to rece:ve the rebate check <br /> direclly, I agree to the foilowing: . <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the(inal invoice <br /> given to the property owner for the installation at the property address referenced above, if ' <br /> the total cost of the installation'is greater than the rebate. <br /> 2. I, the 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 rebate payments lotaling more than 5600 per calendar year, and will ' <br /> report the same paymenls to the Intemal Revenue Service. <br /> I accept the payment of the �ack�vater Prevention Device rebate(rom the Cily of Everett pending <br /> approval of the compieted Back�vater Prevention Device re6ate package.by lhe City ot Everett <br /> � �� � � ����S� <br /> Sig ure ontractor Date <br />