1118 RUCKER AVE 2022-05-12 - Laserfiche WebLink

i � Contractor Section: , ----- — -------- - ---- - J7�1�G�M_I�L�—_ - `"=� G�> — GSFS � Vendor Name/Business Name I UBI Number fll'o// /'G 9�3 GT State of Washington Contractor License NumBer: I . s'yc7 7/s� A�e ,v� r,c.n.svirie �„�,+- 9Sr�7c� Vendor Mailing Address City State Zip j �`�.��s�� I�.7 � Phone Email � � I i � — � i � 'I I, the Vendor,agree to receive the Backwater Prevention Device rebale Gieck direcUy for the installation at the above referenced property address. By agreeing to receive the rebate check Idireclly, I agree lo lhe(ollowing: I 1. The Backwater Prevention Device rebate amount will be deducted from lhe final invoice , given to the propeAy owner for the instaPation at the property address referenced above, if the tolal cost of the instaliation is greater than the rebate. 2. I, the Vendor,am a Washington State licensed contractor. � 3. The City o(Everell will send a Federal Form 1099 MISC lo me, the Vendor,for Backwater Prevention Device rebate paymenls lotaling more than $600 per calendar year, and will , report Ihe same payments to Ihe Inlemal Revenue Service. I accepl the paymen�of ihe Backwaler Prevention Device rebale(rom lhe City oi Evered pending � approval of tlie compleled Backwaler Prevention Device rebate package by llie City ot Everett i � I � � /� 2o/.f I li Signature of Contractor Dale � --- — — — -- --------- I � � i i I I � � , i I I � _