Laserfiche WebLink
Contractor Section: <br />,SMZ.Ca�I'ra�.i�dv5, �L.C. _UBI-fa03-�-r2�i-2D0 <br />Vendor Name / Busi� ess Name I UBI Number <br />.�"M 2 C.o GL. $'� PLZ_ <br />State of Washington Contractor License Number: <br />1�15�3� K��h✓e. NE �.ak��arrsf (-�vk., wrt 9S155 <br />Vendor Wlailing Addre:,s City State Zip <br />�z5-�76-�t3as �2�-.�Iab� �w�a��/• [ow� <br />Pho�e v Email <br />I, lhe Venour, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation al the above referenced property address. By agreeing to receive the rebate check <br />directly, 1 agree to the follo�ving: <br />1. The Backwater Prevention Device rebat2 amount will be deducted from ihe fnal invoice <br />given to the property owner for the installation at the property address referenced above, if <br />the total cost of the installation is grealer than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett will send a Federal Form�1099 MISC to me, the Vendor, for Backwaler <br />Prevention Device rebate payments totaling more than S600 per calendar year, and will <br />repor: the same paymenfs to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevenlion Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevenlinn Device rebate package by the City ot Everett <br />� <br />�'nt Z Cundru[�/urS, L�<- 11- G-/S' <br />Date <br />