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Fron: 09f2312015 17:50 �782 P.0041004 j <br /> i <br /> i <br /> i <br /> i <br /> � <br /> i <br /> i <br /> Contractor Section: <br /> �� n �J [ ' <br /> (�G�n1e1�irlSC�f"�� CLC G�U< 1Jlfl S�c����� !�<�`c�h ; <br /> Vendor Name/Business Nomc 1 UBI Number <br /> � r��uS�Usus�3 Pr� : <br /> -- � <br /> Statc of Washington Contraclo� Licenso Number. <br /> Po r��v� �s5 �3 Sf�.oVe-�°�� t�/r ��8f�» ; <br /> Vendor �4lailing Address City Stale Zip ' <br /> �o� .��� i ��� ��������nj� �,��.������, : <br /> , Phone Email � <br /> �_ <br /> I, Ihe Vendor,agree to receive lhe B�ckwaler Prevenhon Device rebate check dlrectly lor the � <br /> Installation at thc above reference;!propeity address. By agreefn�to receive the rehale uheck � <br /> dttectly, I agree to lhe fcllowing�. � <br /> � <br /> 7. Tha Backwater P-evenlion Device rebate amounl�.vili be Ueducted from lhe finai Invoice <br /> oive�to Ihe pioperty a;mer for Ihe installauon al Ne pmper;y addicss refeienced above, if ; <br /> lhc tota�cost of the i�slailation is greater than the:ebate. <br /> 2. I, Ihe Vendor,am a Washingtnn State I�censed contractor. � <br /> 3 me Ciry of Everen wdi,end�Federal Form 1099 1�115C to me, lhe Vendor,lor Baclnvater <br /> Prevenlion Dewc�rel�te payments totaling mote than�600 per caiendar year, and will � <br /> �eport Ihe samc payments to Me fntemal Revenue Service. <br /> I accepl the payment ot Ihe Aacinvater Prevenlion Dr.vice rebate from lhe City of F�eretl peridiny l � <br /> appmval of tbe cc�mpleted dack6�ater Prevention Dcvice rebate package by thr, City of Everett I � <br /> 1 <br /> ! <br /> i <br /> - �'� _ - � �" ' - --- 1oa.��is� : <br /> 5 Nro of Co ra !or Date ! <br /> � <br /> i <br /> --- -- -- ---- <br /> - - _ _- — � <br /> � <br /> i <br /> i <br /> I <br /> i <br />