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' . .' . . . . . . . � . . . . ti . . ., <br />. . . . .. , ' ' ` ., t . . <br />- - ' . � . . �. . � ♦ . . , �.0 . ' ., <br />Contcactor Section: � <br />�;►zns. :M=ci (Ua.T�. , dti4��uw��i�q`U;C . �az ��z�l <br />� VendorName / Business Name /,U8 Number - • • <br />�Plul�o//P/� <br />State of Washington Conlractor License Number. _ <br />��o!l I�l.i'f� va.y2rt i9?�-�1� � 9�� ; � <br />Vendor Mailing Address City State • Zip <br />425=�89-��Z3 � �n,�rnar.z���r7�C�mrnC-L <br />Phone Email • <br />I, the Vendor, agree lo receive the Backv✓ater Frevention Device rebale check direcUy for the ,: • <br />inslailation'at the above referenced property address..By agreeing to receive the rebate check <br />directly, I agree to the following:. <br />1: The Backwater Prevention Device rebate amount will be deducted trom the final invoice. � <br />� given to the'property owner fo� the installation at the property address, referenced'atiove, if <br />1he total cost of the installation is greater than the (ebate. <br />: 2. I; the Vendor, am a Wastiington Stateiicensed conlractor. '' -' = <br />� 3. The City of EveieH will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />,>� . ' Prevention Device rebate payments totaling more than $600 per calendar year, and will � <br />report the same payments to tfie Intemal Revenue Service. . <br />I accept the payment of the Backwatcr ?�eve�tion Devtoe rebate from the Clry of Everett pendhg <br />approvaf of the completed Backwater p.e'ventlon Devfce rebate package by the Clty of Everett' '.,' <br />��2%u.� / � -� .' , � _ : <br />SignaWre of Contractor - - ' Date ' <br />` ; . <br />� . , ::., . <br />�. • i <br />� . .. ;. . �. . � . <br />. • , , , , . . ; , :', .. : ' . . . .. .. , . <br />