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Contractor Section: <br /> tlr1�#''--�c:L�►�-�C=�'�-G-�-��sl�_.`� �c, ;('� [l-c:_l�«�� :3r%r�3 <br /> Vendor Name I Busine s �ame I UBI Number <br /> A Ni ��.Z_.`-�a-��,�l-l��- -- ----------- <br /> State of Washington Contractor License Number. <br /> ��ta 1-c�.c_Gi�___Lll.' �—�N'�-Ce_1f �,�.7��'�. �G _ <br /> Vendor Mailing Address City State ZiP <br /> �Lb=s�'l�%"���g�—LJ�i_C�S.�E..'-c'1�?�11.�''�-Y�'D�-'-GO/?2— <br /> Phone Gmail <br /> f -- -- <br /> I,the Vendor. �gree to receive the �ack�valer Prevention pevice rebate check directly for the <br /> installation at the above referenced properiy address. By agreeing to receive the rebate check <br /> directly, I a�ree to Uie follo�•�ing: <br /> 1. The Backwater PrEvention Device reba�e amount will be deducted from lhe final invoice <br /> given ro the property owner(or the installation at Ihe property address referenced above, if <br /> the lotal cost of the installation is greater than ihe rebate <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> 3. 1'he Cify o([verett�vill send a Federal Fc��n 1099 MISC to me,lhe Vendor,for Backwater <br /> Prevrntion Device rebate payments totahng more than 5600 per calendar year, and e�ill <br /> report ihe same paymenls lo lhe Intemal Revenue Service. <br /> � I accept lhe p�Yment oF the Backwater Prevention Device rebale from thc Ciry of[verelt pendiny <br /> approval of lhe completed Back�vater Prevenlion Device rebale package�y the Gity oi Everell <br /> CGt4.�—�Ga'�--'`- -- --- —t�Z!�� — <br /> Signalure of Cont�actor Dale <br />