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Contractor Section: <br />�`i ��,�. ����„�,h��, <br />Vendor Name 1 Business Name GUBI Num6er <br />M oen P P�` �S S 3.T O <br />State of Washington Contractor License Number: <br />175i5 �Ilu" i{ <br />Vendor Mailing Address <br />yzs -��v � <br />�hone <br />v� G� <br />Sn� � ur+�'t � <br />City <br />'(rc^ } � i-� o c/1 <br />Email <br />W� �9S"lv"jC1 <br />State Zip <br />iLUN� <br />I, the Vendor, agree to receive the Rackwater Prevention Device rebate check directly for the <br />Installation at the ahovo reterenced property address. By agreeing to receive lhe rebate check <br />directly, 1 agree to the folluwing: <br />1. The Backwater Prevention Device rebate arrwunt will be deducled Trom the final invoice <br />given to the property owner for thc instellation al the property addre.ss reforenced above, if <br />Ihe total cost of the fnstallation is c�rea(er Ihan the rebale. <br />2. I, the Vendor, am a Washington Slate Ifcensed contractor. <br />3. The City ot Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backv�ater <br />Prevention Device rebato payments totalinc� more than �600 per calendar year, and will <br />reporl the same paymenls to the IMernal Revenue Service. <br />I accept the paymeni of Ihe Back�vater Prevenlion Device rebale irom Ihe City of Everett ponding <br />approval of Ihe completed Backwater Prrventinn Devir.e rebate packape hy Ihe City of F_verett <br />�'-�� `�' �2�-- <br />Signature of Contraclor <br />.S��tC -(J <br />Dale <br />� <br />0 <br />'t <br />i <br />i <br />� <br />