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Contractor Section: <br /> n ���� ���`� , <br /> {�{�f'.�'�!C£u�l�'.�-C'--���—�'�Y--�;�C'—�i��'=f� �J <br /> Vendor Name I Business Name I UBI Number <br /> f�:1-_S5�-...�',�— <br /> State of Washington Contraclor License Number. <br /> s;[�Y��-<<.r_ k;_n-t��.�------�� .rr�-�t( I�.�fl U�.'�.�:3 <br /> Vendor Maiiing Address City Slale Zip <br /> .�i.;Iv-�to_ �c:�__ �+�,rU� �.; :�cczr,�S;��JS�� :a:�cm � <br /> Pho�e E�nail <br /> , I <br /> _ <br /> - – - � <br /> I,ihe Vendor, agree to receive lhe Dacicwater Prevention Device rehale check direc0y tor the � <br /> installalion at the above reFerenced property address. By agreeing to receive the rebate checic <br /> direcUy, I agree to the following: ' <br /> i ! <br /> 1. The[3ackv✓ater Prevention De4ice reEale amount will be deducted from ihe final invoice � <br /> given to lhe properry owner for;lhe installaUon aL the property addrese referenced ahove,if i <br /> � the tolai cosl of the inslallation'is c�ieater lhan lhe rebate. I <br /> 2. I,the Vendor,am a Washingtnn State licensed contreclor. <br /> 3. The City of Gverell will send a Federal Form '1099 MISC tu me,lhe Vendor,for Backwalnr 1 <br /> Prevention Device rebatc paymenls lotaling more than$600 per caiendar year, and will ` <br /> repnii the same pa�mienis lo the Inlemal Revenue Service. <br /> ! <br /> I accept�he payment of the Oackwater Prevention Device rebale from the City of Everett pending � <br /> approval of the completed Backtivater Pievenlion pevice rebate package by Ihe Cit�•�f Everett <br /> � � �-� _ ___�_�,�1.�� <br /> Signature of Conir�ctor Date <br />