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�_ . _ _. __ _ . _._ ' _ .__. . . __.-___ _ _._ _ - . _ _.. <br /> 1 � <br /> i <br /> II <br /> I� <br /> � <br /> ' Contractor Section: <br /> � �',%,/d /'/�c,•�I�i _ C/ o <br /> � Vendor Name!Business ame 1 UBI Number : <br /> I <br /> I =�4�,i �c �� cr <br /> , <br /> ! State of Washinglon Contractor License Number: <br /> S�/e7 7/s}A✓e• �� ,+.,cr��k_!1�- —K.1�--�-�>U <br /> Vendor Mailing Address City State Zip <br /> ' �n .Lz.&Zis�� i <br /> �hone Email � <br /> i <br /> I <br /> I, Ihe Vendor, agree to receive th�� Backwaler Prevenlion Device rebate check directly for the <br /> installation at the above re'erencec' property address. By agreeing lo receive ihe rebate check <br /> direcUy, I agree to the folluwing: ' <br /> I <br /> 1. The Backwater Prevention Device rebate amount wili be deducted irom the final invoice <br /> given to the property o�me�for ihe installation al the property address referenced above, if <br /> , the totai cost of the installation is greater lhan the rebate. <br /> j 2. I, the Vendor, am a Washington Slate licensed contraotor. <br /> 3. The Cily of EvereU will send a Fedaral Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate paymenls tolaling more than $600 per calendar year, ond will <br /> � report the same payments to lhe Intemal Revenue Service. <br /> i <br /> i <br /> � — � <br /> I <br /> I accept Ihe payment of Ihe Back�vater Prevention Device rebate from the City of Everett pending <br /> approval of the campleted Backwater Prevention Device rebate package by Ihe Ciry of Everett <br /> � <br /> � ` /���1!�— <br /> i Signalure o(Conlractor Oate <br /> I <br /> I <br /> I <br /> i <br />