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Contra�tor 5ection: <br />� <br />/ir�[',L.� ���i.i��/_�y _L�3 -�i 3 -vSS� <br />IVendor Name I B�siness Nam� ! U91 Number <br />�L� �G�� L� _ <br />� State of Nia� iington Contractor License Number: <br />S`t�7 7��'/fvJ _�vi,- ----- i''�/�1.Z�5✓�l�i W� 9,�r�7_u - <br />Vendor f��ailing Address City St�ie Zip <br />�`L�� �,�'c> > — - - --- <br />Pnore ' Email <br />�, Ihe Vender, 50fP.� �0 fBCcIV2 t!1L' ez�'r:;�c:Bf ?fB'd�flii0tl OEVIC9 f@�c�= cneck dract!y ier ;he <br />-i15lolla:ion at th? d�,OVB fBic'fE�:iCE'[�. riC��i./ cdCfCSS. 6�' c9f2clf7� SO fBC?iVC ihE fE?EB?� Cr�2C{ <br />directly, I agrze to the iolio�titina: <br />L The 6ackwat2r Pr2ven;icn Davi ce �eoate -mount �ei',I L•a de�.c;e:i frc•�� the fn�, nvolc� <br />aiven to the property o�•rner fcr i�i� I�15i8��8;i0f1 9i'rlc; j:f���)i;fi'f i7:j.^.'^SS iB'B(t?^C?Ci 8.';0\'2� li <br />the total cCst oi the installation is oreater tha� the reoata. <br />2. I, lhe Vendor, am a �Vashington St2te licensed contract�r. <br />3. The Cib,� of Everett t•;iil send a Federal Form 1099 i�41SC to �.�a, the Verdor, ior Eackv;a;er <br />Prevention Devir.e rebate payments totsling mcre than SoCO oer calendar pear, and will <br />report the ssme paymer,s to the Internai Revenue Sen�ice. <br />I aaept the payrnent cf the Back��.�ater Prevention Device rebala from the City o` E�rerett pendiny <br />� approval of the compieted Back�vater Prevention �evice rebata package oy the City oi Everatt <br />Sic�nature of Contrac�or <br />— —'�T/ 1 <br />Date <br />I <br />