Laserfiche WebLink
Contractor Section: <br />%t� ec' �� ���cn r� �� r� � <br />Vendor Name / Business Name UBI Number <br />_l'�OL'n l�(� ;Y dh 3. O --- <br />State oi Washington Coniractor License Number: <br />(:� v <br />G� <br />��5 i s �ir � s� s�= s„�I,�r-,rsG, ��r �I�a�io <br />Vendor Mailing Address City State Zip <br />`�.25 7(,U 4s3�t� Trc�' �J ��ocil.,l�„r,�,'��y,co,�, <br />Phone Email � �— <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check direclly for the <br />installalion al the above referenced property address. By agreeing lo receive the rebate check <br />dlrectly, I agree to the following: <br />1. The 8ackv�ater Prevenlion Device rebate amomit will be deducled irom the final invoice <br />given to the property o�vner �or the installation at the �property address referenced abovo, if <br />the total cosl of Uie installation is grealer than Ihe rebale. <br />2. I, the Venuor, am a Washinylon Stale lieensed contraclor. <br />3. The City o( Everett will send a Federal Form 1099 MISC to me, lhe Vendor, for Bar.kwaler <br />Prevention Device rebai� paymm�ls tolaling more ihan $600 per calendar year, and will <br />report lhe same paymenis lo lhe Inlemal Revenue Service. <br />I acr.ept the payment of the Ciar,kwater Prevention Device rebate from Ihe City of Everell pending <br />��pproval of Ihc� compl�led Dackwater Prevention Device rebatc packa9e by lhe Cily of Cvcietl <br />I P / L <br />������ �. �7 Lc.�_ <br />Signalure of Contractor <br />����� �����. <br />Dale <br />