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Contractor Section: <br />•.%,y��z_l� - -- <br />Ven or Name / Busmess Name / UBI Number <br />� � . <br />� 5�-,��� C� _��L(_Gr��/ <br />State of VJas ington Contractor License Number <br />�fS �f C�� � �- ��i- -- <br />Vendor Ma�l�nq ddress City <br />`� . �x � 37 ;�,'� ', <br />Phone <br />�G�S- 7 <br />� <br />Finail <br />--� <br />� aZ �Sz v/ _ <br />State , Zip <br />i!he Vendor, agree lo receive the 8ack�valer Prevenlion Device rebale check directly for the <br />�nstallation ai Ihe above referenced property address. By agreeing lo recaive lhe rebate check <br />drteclly, I ayree lo the (ollov�ing. <br />1 The Back�vater Prevention Device rebale amount wdl be d`^ted from the final invoir.e <br />given to the property orvner for the inslallation al the propr, , address re�erenced above, if <br />Ihe total cost of the installation is greater Ihan Ihe rebate. <br />2. I, the Vendor, am a Washington Slale licensed conlractor. <br />3. The City of Everelt will send a Pederal Form 1099 MISC to me, lhe V�ndor, for Backtivaler <br />Prevenhon Device rebale payments totaling more than 5600 per calendar year, and wdl <br />report the same payments to Ihe Internal Revenue Servicc. <br />i---- -- ------- --- ------ _ <br />I accept the payment of lhe Backwater PrevenUon Device rebale from the Ciry oi Ev�retl pendiny <br />upproval o( lhe complcled 8ackwaler PrcienUon Device rebate package by the City of Evr.retl <br />g . ture of Contract <br />:� <br />�3- /2--2�f S- <br />Dale <br />N <br />_J <br />