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� � �'. <br />;�����JJJ�...''' <br />�yrCTT <br />-� <br />Backwaiter Prevention Device <br />F;ebate Prc�gram <br />Vendar Section (please print): <br />r__ _------ --- — ----------- ----- <br />�� tUti�f_f'>E1L' L. i C OC_ <br />-� --S—C �,�,F1� r�_ I ��c . (�� c� � 12(�� I 1`t <br />� ,�endo� N�nne i Ousmess Name / URI Numher � <br />� __ i r1r�,�^Gr� � c: �-1 �•� <br />- -�---�—� - -- — <br />Stale of'J�±:�>hing,un Contractor License Nwnher <br />�� -C hi-� �?�i�.l .__ C'v=::'_:=-i'i_ � ,.,�\ �-j � � <br />� -- - ---- ------=----- �'�'--- <br />Vendor ivlailinq Addr<.,ss City SL:�tc 7_i� <br />' .- <br />I �'i L'j ': j �i - �'P�'`) >�'f�' llC �'�j Lc�����1�� (�5���`ai �)�rlc� : Ci_.�n <br />; PI•�un� Emai! ' _—. <br />'� th� V�mdor, ayree to �eceive Ihe E3a�kv;al���r Prevent�on Device rebate chech directly <br />'c � the installation referenced at the Pioperty Address F4y agreeiny to receive the rebafc: <br />�-r.4 directly, I agree to th� followin,�. <br />Tne 8�ickwater Prevention Device rebate amount ��rdl be deducted from the final <br />��.�oice given to the Property Ov;ner (or the mstallation at the Property Address <br />fe, enr.r.d r,bove, if the tntal cosi of the installa�i�m is grealer than the rebate. <br />_ tha Vendor, am a Wasning`�n Stale hr,ensed r.untr;�ctor <br />i���� City nf Everett �vill senr � Federal Form 1099 �viI5C to me, lhe Vendor, (or <br />t�,e E3ar.ku�ater Preventic, � �vice rc�bale �ayments totaling more than $600 per <br />,.�,'��nJ..� ya:�r, r�nd �vill m�i��rl Uie sni•��c �ia�'m�tnSs ;u �he I�i(em[il Revr,n�,�e <br />S��r:ice <br />I,�r����c���f II��, .h�r:cl r�i��,�icnt n( ih�� f;,rh�+:<�'��� f'���v,=ntion Devir.<a rebate (rom lli�� Cify <br />n' f�verelt F;�a�nil�ng a��n;����al nf Uu� r.onq,l�:,r,�f I���c4�:-al��r I'i����en�.nn D��vice r��h;it;, <br />I'���.h��g�' by thr: CitV OI I�vrretl <br />,ti <br />.ln,�r.,+'r�./,'Crr�.�rr:l`,, — <br />Rrrl��_•,� ��, i'?,1�;,; <br />���`- <br />1- - - _� <br />i)nh. <br />P.aq�� ? n' Z <br />