Laserfiche WebLink
Contractor Section: <br />Vendor Name / Business Name / UBI Number <br />ViGT— <br />Statr of Washington Contractor License Number: <br />S�/c; 7�s' A✓� ivF rlwrrsy;i�— W� �-'�s�?v_ <br />Vendor Mailing Address City State Zip <br />7 /So7 <br />Phone Email <br />I,.lhe Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following. <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to th^ oroperty owner for the installation at -the property address referenced above, if <br />the total cost of the installation is greater 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 Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of -Everett <br />2A3 _ice <br />Signature of Contractor Date <br />