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,,r . . , - .<.. -- •- <br />l•;, ���„. . � <br />� �.. . <br />i...�. <br />� �.;• . <br />i <br />� Contractor Sectton; <br />1 --r' � .� <br />��� <br />Vendor Name / Business �f5me <br />i �S��c� ; <br />� <br />State of Washin ton Co�tractor <br />� �, .�x i3. 7 <br />Vendor �AaiGng Address <br />I UBI Number <br />Number: <br />�ho�� l 7�'��'T(��)Em�i� <br />�, �`��� �' <br />City State <br />-� ----- ._------�� <br />I, the Vendor, agree to recoive the Backwater Preventlon Device rebete chock diredly for the (/ . <br />installation a: tha above referenced propeAy address. By agreeing to receiv� the rebate checfc <br />. directly, I agree to the (oflowing: <br />1. The Backn�ater Prevenlion Device reGate amouN will be deducted from the finel Invoice <br />' givon to the property owner for the I�stallallon at :he property address referenced above, if <br />the fotal cosl of the mstallallon is gmeter then the rebete. <br />2. 1, Ihe Vendor, nm a Washirx�ton Stete 7^ansed contractor, <br />3. The City ot EvQrett will send a Fedaral Form 10P9 �AISC to mo. Ihe Vendor, fnr Beckwater <br />Prevenlion Device rebate payments tololing mare than 5600 per celendE+r year, and wlll <br />report lhe same paymonts to Ihe Intemal Revenue Service. , <br />I accept d�e payment ol che Backwater Prevention Device rebete from Ihe Ciry ot Eveiett pe�ding <br />approvat of Ihe completed Back�veter Prevention Device rebale package by the City of Everett <br />,.� - �� -- i.SJ <br />Date <br />t •, <br />1 • <br />i ' � <br />� .. <br />r <br />� <br />