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i-- :. •-•�— -. ..� __..— .—,--._ . __._ . -•---____. .. _- -- - - - ------ -._. __ . <br /> � ' � <br /> . • � <br /> ' J � <br /> � � � <br /> , � <br /> � � <br /> � Contractor 3ection: � <br /> 1 __ ; <br /> ( : i ; <br /> A+Sewcr Technoloales <br /> Vendor Name/8usiness Neme!UBI Number <br /> � <br /> ' 603 089 164 <br /> � State of Washington Contrador Llcanse Number: <br /> . � <br /> � 900 Meridian Ave E STE 19-193 Milton WA 98354 <br /> � Vendor Mailing Adtlress � Ciy State 2ip <br /> � RR8)7.13-7656 in(o@sewertechs,com <br /> Phone � Email <br /> � I <br /> � <br /> � <br /> � I, Ihe Vendor, apree to receive ihe 8ackwaler Prevention Devlce rebale check direcUy for the i <br /> inslallal'wn at the above referenced property address. By agreeing to recefvo the rebate check , <br /> directy, I agree to the followingi ; <br /> 1. 7he Backweter Preventlon Device rebate amount will bo deducted from the tinal invoice <br /> given lo the property owner for 1he instailefion al lhe propetiy address referenced above,if <br /> ihe fofal cost nf the installation Is greater than thc rebafe. <br /> 2. I,the Vendor, am a WaShington State licensed coniractor. <br /> I <br /> ' 3. The City of Everett will send a Federal Form 1099 MISC to me,the Vendor,for Backwaler <br /> � Prevention Uevice rebate paymenls totaling more than $600 per calendar year,and will : <br /> report tho sam� peyments lo thc Intern»I R .wenue Sorvice. � <br /> , I <br /> -— --� --- <br /> • I accepl the payrnent of the �ackwater Prevention Device rebate from tho City of Fveretl pending <br /> approval of Ihe completed Deckwater Prevention Dovice rebate package by the City nf l�verett <br /> � : <br /> I , <br /> � <br /> ' W�b+b�e wn � <br /> Walt ;.,��.���..�, . � <br /> w..rw«�aM.�n -�' <br /> I "� <br /> uv.z�em��oronn anv _�j�//.�-- <br /> � . <br /> Signeture of Contractor , Date � <br /> j � - � -- - -- <br /> , <br /> � � � <br /> ` i <br /> I <br /> , .. . . , � <br /> � . <br /> � � <br />