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Contracfor �ection; <br /> Scw��- �r �enn f,�n L�-c � t� o Z °3� 7 8D <br /> Vendor Name 1 Busine�s Name;UBI1Vumber <br /> SewGV" -r 1,- �}1 l� Y� S <br /> State oi Washingion Coniractor Licensa Nunber. <br /> �c-� �X �-;-IS L�„-,n��a� lN �8"a�(� <br /> Vendo� Mailing Address Ci.y Stat= Zip <br /> �Dl� 8�0 �i�� 8 �����P"C�S�;wer -ri�►��.�pm <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly ior the <br /> installauon at the above referenced properry adoress. By agreeirg to rec=ive the rebaie check <br /> directly, I agree io the following: <br /> 1. The Baclavater Prevention �evic�rebate amount will be deducted from the finai invoice <br /> given to the properiy o�mer ior the insiallation at ihe proper,r address re�erenced above, If <br /> the total cosi o`the instail2lion is greater ihan tFe rabate. <br /> 2. i, ihe Vendor, am a Washinaion Stale licensed coniractor. <br /> 3. The City o�Everett will send a Federal Form 1099 MISC to me, the Vendor, fior Back�vater <br /> Prevention Device rebate paymenis 1o121ing more than S600 per calendar year, and will <br /> report the same paymenis to the Iniemal Revenue Service. <br /> I acceot[he paymont oi�he Baciovater Pre��enllon Device rebale irom the Ciry oi Evere[i pending <br /> approvai o�,he completed (3acl.water Prevention Device rebate pack2ge by the City of Fverett <br /> /�v��� ��� <br /> . <br /> Signature ot Contraclor �a�� <br />