Laserfiche WebLink
� Backwater Prevention Device <br /> Rebate Program <br /> Vendo� Section (please print): <br /> C n�F6�Lll� t'LUfi1F�liV hi In1C � � O�L. ����v ��� <br /> Vendor Name I Business Name/U81 Number <br /> C.F�r�1P G_P r�jc, _ �II �1n S <br /> Slate of Washington Contraclor License Number. <br /> , � B�ti 55� i ���-rr c�A `i�s��, <br /> Vendor Mailing Address Cily Stale 7i� <br /> �>_ZS��i- ���s�g 5�r���e JCa,�P�ells� Plv��h;r�ti � t���� <br /> Phonc Email <br /> I, the Vendor, agree to receive the 8ackwater Prevention Device rebate check directly <br /> for tlie installation referenced at the Property Address. By agreeing to receive the reba�e <br /> check directly, I agree to the following: <br /> 1. The Backwater Prevenlion Device rebate amount will be deducted from the final <br /> irnioice given to the Property Owner (or the inslallalioti at the Property Address <br /> re`ierenced �bove, if the total cost o(the installation is greater ihan thr rebate. <br /> 2. I, Ihe Vendor, am a Washinylon State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, ihe Vendor, for <br /> the f3acicwater Prevention Device tebalc payments totaling more lhan $60D per <br /> calendar year, and will report the same payments to the Intemal Revenue <br /> Servir,e. <br /> I accept the direct paymenl o(Ihe Backwater Prevention Devi�e rebate from the Ciry <br /> of Everelt pending approval of Ihe completed Bar.kw�ter Prevention Device robate <br /> packag� by the�iLy�f Fvcrett <br /> _ � j_ <br /> (,-�I. --- _ _ . . . � ✓(c� � ��r <br /> Sig{ialui�l Cont�aclor � Dafe <br /> Rr.•disi�d 9I317014 <br /> Page 2 0(2 <br />