Laserfiche WebLink
-. , <br />:�: <br />� . <:: � <br />:; � , , , <br />: . , _, . , : <br />�> ; - ; , _ °:, <br />, <br />., <br />�� . . � <br />Contractor Section: <br />�d �i lZ � �t`_ � Vci,�Z^ �"� ��U M U( VL� �.�-(_ <br />Vendor Name / Businoss Name / UBI Number (y p 2— 7d'�- �'� t� <br />rf►r� �Ll.�vrl�� . <br />State oi Washington Contractor License Number. <br />—� C � /I/ s��-u.l%1 (��'�"�—L�L� �,�7�%i f(/�- � �� �� — <br />Vendor Mailing Address : City Slate Zip <br />L.iz� y�: —v;� � �z9 F��-,1�,�� ,� cc c_�-4 �� Ci� <br />Phone Email J <br />I, Ihe Vendor, agree to receive the Rackwater Prevention Device rebale check direcUy for thE <br />instatlation at the above referenced property address. By agreeinp lo receive the rebate checK <br />direclly, I agree to the tollowing:' <br />1. The Bacicwaler Prevention Device rebate amount will be deducted imm the final invoice <br />given to lhc property owner for Ihe inslallafion at the property address referenced abovo, if <br />lhe lotal cost o� lhe installation i's grealer than the rebate. <br />2. I, the Vendor, im a Washington S�ate licensed contractor. <br />�. The Cit�! �.' `.=veretl will send a Federal Form 1099 MISC to rnc, Ihe �'endor, for Backwater <br />Prevc:n!inn Device rebate paymenls lotaling more than $600 per caicr.dar year, and will <br />rep.�rt tl�a same paymenls to the Internal Revenue Service. <br />I accepl Ihe payment of the Backwalcr Prevenlion Device rebale fram the City of Ev�rett pending <br />approvat ot the completed Dar.kwaler Prevention Device rebate package by Ihe Cily of tverett <br />�.�_ _[e•ill-c� <br />Signature ot Conlractor Date <br />: <br />� � <br />