Laserfiche WebLink
i <br /> I <br /> � <br /> � <br /> i <br /> Contractor Section: . � <br /> - -- ' <br /> — - ---- , <br /> _, � -IJ''� � <br /> W�}✓,�j��-�----r-7t.'��G—`�-�-� . ,iti{�'�LLG U-'> . 1•'�.'3 i <br /> Vendor Name I Busine�s Name I UBI Number � <br /> ; <br /> _9L�9�.z`���-�-�-K�-�--------- - i <br /> State of Washington Contracror License Numbec <br /> .�1���_Lq r_����_e,- EN��i�_u.�� _s'S�c3. � <br /> � <br /> VendorMailingAddress City Slale Zip ; <br /> a��.�o��ga C•,�ds_c_i_c.� �a �����r''L ' <br /> Phone Email t <br /> i <br /> _ � i <br /> i <br /> I, lhe Vendor,ac�ree to receive ihe Backwater Prevenfion Device rebate check directly for fhe ; <br /> inslailation at lhe above referenced property address. By agreeing to receive ihe rebale check i <br /> directly, I agree to the following� <br /> 1. The Backwater Preven�ion Device rebate amount will be deducled from the final invoice <br /> , j <br /> given to ihe property ov+ner for lhe installation et Ihe properly address refere.nced above, if � <br /> i <br /> Ihe lotal cosl of thc insbllation is greater lhan lhe rebate. i <br /> 2. I, the Vendor, am a Washinglon Stale liconsed contraclor. i <br /> 1 <br /> 3. 7he City o(Everett will send a Fr.deral Fnrm 1099 MISC to me,fhe Vendor, (or Backwater � <br /> Prevontion Device rebate payments lotalinc�more than$600 per calendar year, and will <br /> report the same paymenls to the Intemal Revenue Service. � <br /> I accept the paymenl of the Backwater Prevention Device rebate fram Ilie City����erett pending � <br /> aUproval of the compleled Backwaler Prevenlion Device rehale package by the City of Everett i <br /> I <br /> �.���-.--�'��.--�' - -- -���� -- i <br /> Sit�nature uf Contrar.tor Dalc � <br /> I <br /> I— J— � <br /> --- -- S <br /> I <br /> i <br /> � <br /> I <br /> i <br /> � <br /> ! <br />