Laserfiche WebLink
Contractor Section: <br />��l��l�s Pl,..,���. I�� , <br />Vendor Name ! Business Name / UBI Number <br />C�rn� 3�r 9�� �s <br />State oF Washington Contractor License Number: <br />� <br />,�o. ,3�,re s S yr ��e.re�T __ U1 � <br />Vendor Mailing Address City State <br />�zs� �s`�- 3 F� <br />Phone <br />Email <br />�, y 2oc <br />Zip <br />C� G4-r�6�f�s - <br />I, the Vendor, agree lo receive the Backwater Prevention Device rebate check direclly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />direclly, I agree to the tollowing: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner tor the installation at lhe properly address referenced ahove, if <br />the total cost of the installalion is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed r,ontractor. <br />3. The City o( Everett will send a Federal Form 1099 MISC to me. the Vendor, for 8ackwater <br />Prevention Device rebate payments lotaiing more than 5600 per calendar year, and will <br />report lhe same payments to lhe Inlernal Revenue Service. <br />I accept lhe paymenl ot t�e Backwater Prevention �evice rebate from the City of Everett pending <br />approval of the compieled Backwaler Prevention Device rebate package by Ihe City of E�:erett <br />, /� a��- ,� <br />��. � ,� � �/� y <br />Signature of Contractor Date <br />