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Contractnr Section: <br />Muen ����,�ti�N <br />Vendor Name / Business Nama <br />L L C. <br />UBI Number <br />M v �=�` �� � � `S�S S .� i� <br />State of Washington Contractor License Number. <br />f 75 IS ��`r SJ ' <br />Vendor Mailing Address <br />y� f 7�U <br />Ptione <br />�3 — yc�3— SS(.,� <br />Sn���m� ���. <br />city <br />i �<,n�" L�% r�l ozn <br />Email <br />�F� <br />State <br />�ib'Z`iU <br />Zip <br />ii-t .Gc.�ti <br />I, the Vendor, agree to receive Ihe Dackwater Prevention Device rebale check directly for the <br />installation at the above re(erenced property address. By ayreeing to receive the rebale check <br />directly, I agree to Ihe following: <br />1 <br />2. <br />3. <br />The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for ihe installation at the propeAy address referenced above, if <br />ihe total cost of Ihe inslallalion is grealer lhan the rebale. <br />I, lhe Vendor, am a Washinc�(on Slate licensed contrac�or. <br />The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for 13ackwafer <br />Prevenlion Dovice rebatr, payments tolaliny more than �600 per calendar year, and wiil <br />report �hc same payrnents lo the Internal Revenue Se�vir.e. <br />I acoept the payment of lhc [3ackwaler I'revenlion Device rebate from lhe Ciry of EvereU pending <br />approval of Ihe cornple(od [3nckwatrr Prnvenlion �evlr.e reb�de p�cka�e by the Ciry of [verell <br />��'�'a� - <br />Signature of Contractor <br />�_,-r -cf" <br />Date <br />