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i <br /> i <br /> I <br /> Contractor Seclion: <br /> �5�«`�es�"o R,m a.�� �.�� / (o�- ��S-/�� i <br /> Vendor Name I Busmess Name; UBI Number <br /> � S ��2�5 - --- --- <br /> State uf Washington C ctor License Number: <br /> � �o��_-��C�`' S-� SG� ���� i.�?�.? ��o'�d� <br /> i Vendor Mailing Address City State Zip <br /> i // <br /> I �"� ` <br /> ' �I� ' /�93 ��u�eS�Der-�4hc�5eWe�,�}Grtar� ���y <br /> , Phone Email <br /> II,the Vendor, agree to receive lhe Backwaler Prevention Device rebate check directly for the � <br /> � installation at the above referenced propeAy address. By agreeing to receive the rebate check <br /> directly, I agree lo the following: <br /> � � <br /> 1. Tho Back�vater Prevention Device rebate amoun;wili be deducted from lhe final invoice <br /> � givan to the properly ownsr for ihe installation at the property,address referenced above, if <br /> Ithe lolai cost ot the installation is greater than the rebate. <br /> 2, I,the Vendor, arc a Washington State licensed contractor. <br /> � 3. The City of Everett will sond a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate paymenls totaling more than 5600 per calendar year, and will <br /> report ihe same payments lo the Intemal Revenue Service. <br /> i <br /> � _ - - - — <br /> I accept the paymenl of Ihe Backwater Prevention �evice rebate from the Cily ot Everett pending <br /> iapproval of the completed Backwater Prevention Device rebale package by the City oi Everett <br /> � �'�j,,,,, � , 3--�' �l3�.� <br /> �.�-t�--- <br /> ' ignalure of Contractor Date <br /> � <br /> - -- -- -- <br /> li <br /> I <br /> I <br /> I <br /> � - _ _ - . . . . . <br />