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,. .) l� I � . . . . . � ' ... .. <br /> i . Y `L ;F. I��1 ��� �� �• ��._\ . ' 1 .� . . <br /> , _ x:�,� , � -�,r���: ti:. , . <br /> i � . � � � ;+5� . � <br /> I Contractor Section: <br /> i - -- -- - - --------- - -- <br /> ' (X�3 0/3 o s� <br /> APa//�, ��iur�ISi., <br /> Vendor Name/8usiness Na e I UBI Number � <br /> Apo//PL �G3 T <br /> State of Washington Conlracror 'License Number: <br /> ' 5�,�7 7/s'�.4��' r/G �c,s��vi//e �, � �70 <br /> �� Vendor Mailing Address City State Zip <br /> 'i, (iZs� 3��- �s� � <br /> Phone Email <br /> � <br /> � I, the 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 lhe rebate check <br /> I directly, I agree to the tollowing: <br /> i <br /> � 1. The Backwater Prevention Device rebate amount wiil be deducted from the fin21 invoice <br /> � given to the property owner for the inslallalion at the property address referenced above, if <br /> j the tolal cost of the inslallalion is greater than the rebate. <br /> 2. I, the Vendor, am a Washington Stale licensed contractor. <br /> 3. The City of Everelt will send a Federal Form 1099 MISC to me, lhe Vendor, tor Backwaler <br /> IPreveiriion Device rebale paymeNs totaling more lhan 5600 per calendar year, and will <br /> � report the same payments to the Intem2l Revenue Service. <br /> 1 accept the qayment of the Backwaler Prevenlion Device rebale from Uie City o(Everett pending <br /> i approv2l oF the completed Backwater Prevention Device rebale package '�y the Ciry of Everetl <br /> I <br /> I _ � <br /> �_ _f� /S%/� <br /> i, <br /> � Signature oF Contractor Date <br /> � --- -- — <br /> � <br /> i <br /> ' I <br /> I <br /> i --__ _ _ _ —. _ _ _ <br />�i <br />