1422 RUCKER AVE 2022-05-12 - Laserfiche WebLink

I. . .__ _ . . _ .. _ _. .._ _ _ . _ I �� Contractor Section: , � i A /_ 7 Q , �� /'I�o//C/ �/H/lB,n9 W.J G�.7 GS` Vendor Name 1 Business Name/UBI Number - -�'��_J_�a3G_�_ -- - -- � Sta;e of Washington Contractor License Number: i I . � s�/o7 7i A�� ,vF �o.rs�i��a �.,,,4- t$z7d , Vendor Mailing Address City Slate Zip II v�S� 3�s7- is�7 � Phone Email j � I, the Vendor,agree to receive the Backwater Prevenlion Device rebate check directly for the I installalion at the aba�e referenced property address. By agreeing to receive the rebate check �I directly, I agree to the following: ' 7. The Backwater Prevention Device rebate amount will be deducted from the final invoice i � given to lhe propeRy owner for the inslallation at the property address referenced above, if I � the lotal cost of the installalion is grealer than the rebate. �I 2. I, the Vendor,am a Washington Stale licensed contrar.loc 3. The Cily of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater � Prevention Device rebate payments totaling more than$600 per calendar year, and will ' report lhe same payments to the Internal Revenue Service. ' � i — � i I accept lhe payment of the Backwater Prevention �evice rebate(rom the City of Everelt pending ' approval of the completed Back�vater Prevention Device rebate package by the City of Everetl i � ,.i�f �_._ ��-- _ � �"� l2/3�/ . l � Signature oi Contraclor Dale I I � _ _ �