2202 ROCKEFELLER AVE 2022-05-11 - Laserfiche WebLink

� _ . I I I i ' Contractor Section: �� 1-�1�O PCU m(3�N Cp (CO lI i�/�3o Swrs�c. � �P.O 3 -42S= 0(C�z. � - Vendor Name 1 Business Name 1 UBI Number N(�o PP�Bc�3Ni i — � State oi Washington Contractor License Number: � ; Po F3ok s8� sNol�rrn�s�+ wa. . 98�9 � � Vendor Mailing Address City Slale Zip ' � `�DC� �f�-OR 29 ��r'e�t cot t r drs Q YaNflo.Ce.h � Phone Email ck i tl f r he � I, the Vendor, agree to receive the Backwater Frevention Device rebate che d rec y o 1 installation at the abuve referenced property address. By agreeing to receive the rebate check I � directly, I agree to lhe following: ; � 1. The Backwater Preven!ion Device rebate amount will be deducted from the final invoice Igiven lo the property oaner tor the insfallation at the property address referenced above, if � Ihe total cost of the installation is greater ihan the rebate. i 2. I, the Vendor, am a Washington State licensed contractor. ! ! 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater Prevention Device rebate payments to�aling more than 560G per calendar year, and wiil I report the same payments to lhe Internal Revenue Service. I i � i ; I I accept the payment of the Backwater Prevention Device rebate(ron; the City of Everett pending ; i� approval of the compleled Backwater Prevention D�vice rebate package by the City of Evere�t ; �—G� r 2 _ / 7- (g i I �� — Signalure of Contraclor Dale i � __ i I I � I i