1208 RUCKER AVE 2022-05-12 - Laserfiche WebLink

i � . ; � Contractor Section: i — --- --- --� � � �_ f � �Lr�'(�,��i9�. _ ' 1-' '� t—�-'�'C�__/�C%�i.�i�4T?.3 Vendor Name I Busine s Name I UBI ��umber i i � �1��;5��`.�-�.��._� --1�_� _ , State of Washington Contractor License Number: �� Lc�.r=�i_�—D1'>.—��r'�'1�tf"_C��S_•�G�- ' , I Vendor Mailina Address City State Zip � ' % 1��c�,� ' l a„r�-a�:i��t�s-� C�.nd�.r�c��_:�:��- sJ--� ; IPhone Email i I ,_ i I, the Vendor, ayree to receive the Bzckwater Prevenlion Device rebate check directly for the f installation at the above referenc=d property address. By agreeing to ieceive the rebate check directly, I agrce to the follo�vina ' 1. The Backwater Prevention Device rebate amount will be deducted from Ihe final invoice given ro ihe property oH�ner for lhe installalion at lhe propeRy address referenced abovc, if , the total cost of the installation is greater than the rehate. i 2. I, the Vendor,am a 1Nashington State licensed contracloc � 3. The City of Everett will send a Fe.derel Fortn 1099 M�SC to me, the Vendor, for Backwater Prevention Device rebale payments totaling more than S600 per calcndar year, and�vill i report the same payments to ihe Internal Revenue Servi,;e. I I accepl the payment of the Backwater Prevention Device rebate from lhe City of Everett pending ; approval of the eompleted Back�vater Prevention Device rebate package by the City of Evciett I l i �'��G� -----_ �� Signalure of Contractor Date � i - — --- — — � I i � ; ,