Laserfiche WebLink
Contractor Section: <br />Vendor Name / BusineSs Name / UBI Number <br />C�STCC�. �j fpZ�—a- <br />Slate of ashington Contractor License Number. <br />�D �v'a--,C /� � �nA , � � ; f -l� <br />� <br />Vendor Mai6ng Address Ciry Slale Zip <br />I, ihe Vendor, agree to recerve the Backwater Prevention Device rebate check directty for Ihe <br />installation al the above referenced property address. By agreeing to receive lhe rebate check <br />directly, I agree to the following: <br />1. The Backwaler Prevention Device rebale amounl veill be deducted (rom the final invoice <br />given to the property owner for Ihe installation at the property address referenced above, if <br />the total cost of lhe inslallation is greater than the rebale. <br />2. I, Ihc Vendor, am a Washington Slate licensed conUaclor. <br />3 The City of Everetl �vdl send a Fede� al Fonn 1099 MISC lo rne. �he Jendor, for Backwater <br />Prevention Device rebate payments totaling tnore than SG00 ��er calendar year, and will <br />reporl the same payments lo Ihe Intemal Revenue Scrvice. <br />I accept lhe paymenl of �he Backwaler Prevention Device reba!e from Ihe City of Fverelt pending I <br />approval ol the wmpleted Hackwaler Preve�tion Device rebate package by Ihe Cily of Everelt <br />///��� �� <br />Si p� re of Contr cl r Date <br />� <br />0 <br />E <br />� <br />u <br />I <br />