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Conteactor Section: <br />Vendor Name ! Business Name / UBI Number <br />�M� "���1�� �� <br />State of Washington Contraclor License Number: <br />�a�� ��z.r�L�n ,1��--��Nn:if� +.t�fl Gi�`�3 <br />Vendor Mailing Address City Slate Zip <br />�dv=�1C._�c::�� ''L.� nd:���n rr�r� ��h:SE,�w,� <br />Phone Email <br />I, the Vendor, agree to receive the 6acicwater Prevention Device iebale check directly for the <br />inslallalion at the above referenced property address. By agreeing lo receive lh� rebate check <br />direcUy, I agree lo the tollowing: � <br />i <br />7. The Baclnvaler Prevenlion �eyice rebate amount will be deducted from the final invoice <br />given lo the prnperty owner (or lhe installaUon at the property address referenced a6ovc, if <br />the totai cost of tfic instailalion�is greater lhan the rebale. <br />2. I, the Vendor, am a Washington Stafe licensed contrador. <br />3. The City ot Everelt �t�Il send a Federe� Form 1099 MISC lo me, Ihe Vendor, for Backwa'cr <br />PrevCntion Device reba�e paymenls lotaling more than 5600 per calendar year, and will <br />reporl lhe same payments to Ihe Inlemal Revenue Service. <br />I accept the payment o( the Backwater Prevenlion Device rebate 6om the Ciry of Everell pending <br />approval of ihe completed Back.vater Prevention Devir,e rcbale packagc by Ihe City o( Evereit <br />� -? ��� �_�� <br />Signaturc of Gonira�tor Date <br />:c�rr�� <br />