1226 RUCKER AVE 2022-05-12 - Laserfiche WebLink

! � 1 I Contractor Section: � � I -, . , ��D�1d�+'1�Z;.sL�' (�'> -�il 3 - U 5 Sl ' Vendor Name I Business Name I UBI Number � � � �1l� , U� � ! Stata of lNashington Contractor License Number: i S�/o7 '7/�r�+�= Nj;. it1/�12Y5 'vZL�i' lNA Q�S�7c� � Vendor Niailing Address Cily Stale Zip ; ' :.�� "��7 ` i ; I Phone Email , — � I, the Vendor, agree to receive ihe Backwater Prevention Device rebate check directly for the installation at the above referenc=d proper�y address.By agreeing to r2ceive the rebate check ; directly, 1 agree to the following: 1. The Backiti•ater Prevenlion Device mbata amount�vill be deducted from ihe final invoice given to tho properly owner for the inslallation at lhe property address re(erenced above, If the total cost of the instailation is greater than the rebate. 2. I, the Vendor, am a Vdashing,on State licensed contractor. 3. The City ot Evereri�,�ill send a Federal Form 1099 MISC�o me,the Ver.dor, fcr Backtva�er i Prevention Device rehate payments tolaling more than SG00 per calendar year, and��aill report lhe same payments to ihe Internal Fevenue Service. � �1 accept the payment of the[3ack;vater Prevention Device rebate from the City of Everett pending � , Iapproval of the completed Backwater Prevention �evice rebate package by the Ciry o�E��orett � i t//� JJ/is � Signature of ConVaclor Date ; i — . i i ;