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i <br /> Contractor Section: . <br /> �y1�Cc�J�--��'��' -.�cc��[1'� L-l'C� — a3 ; ��d.3 <br /> Vendor Name 1 Busine s Name I U81 Number <br /> .�.L`�_�:I`�-�-�—�� <br /> Slate of•Washington Gontractor License Number. I <br /> a���r�����-�---�N�.c�-i�—����'�K�_O� <br /> Vendor Mailing Address City ' Slate Z�P <br /> ��r�ga L��r�ds:-C�s.�.�a-���s-r'h'1 <br /> Phone Email <br /> I,lhe Vendor,agree to receive ihe Dackwater Prevenlion Device rebate check direclly for the <br /> installation at Ihe above referenced properly address.6y agreeing to receive lhe rebate check <br /> direclly, I agree lo the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducled from the final involce <br /> given to lhe property owner for lhe installation at lhe prapeRy address referenced above,if <br /> Ihe lolal cost of the inslallation is greater than lhe rebate. <br /> 2. I,the Vendor,am a Washington State licensed contractor. <br /> 3. The City ot Everett will send �med srtolalin� more han�6D0 per calenda�year,and w Ilef <br /> Prevenlion Devir,e rebate pay <br /> reporf ihe same payments lo tlie Internal Revenue Service. <br /> I accept the payment of the Backwater Prevention Device rebate from the Ciry of Eveiett pendiny <br /> approvai of the compleled Backwater Prevenlion Device rebate package by the City of Everefl <br /> i <br /> ��� Date^ �— <br /> Signature cf CoNracror <br />