Laserfiche WebLink
Contractor Section: <br />�`i�t-!'I3--J"-�-i-C'�-5E-�,-5 �;.t�;�('� LL,G (c,�c�'- ;31�}-�:s <br />Vendor Name I Busine s Name / UBI Number <br />�_I���'�L.`_�`�-.`=5-�' �-� �" - <br />State of Washinglon Contraclor License Number: <br />Vendor tvlailing Address Ciry State ZiP <br />��7�% �L��_—L'�r)c�iJ'�C.e._�,.a�_�'�dtt�Q�_C'�Y�%-- <br />Phone Email <br />I, the Vendor, agree to receive ihe Dackwaler Prevention �evire rebate cheek directly tor the <br />installation al lhe above referenced properiy address. By agreeing to receive lhe rebate check <br />direclly, I agree la the (ollov�ing: <br />1. The Backwater Prevenlion Device rebate amounl �vill be deducted from the final invoice <br />yiven fo thr� property owncr for Ihe inslall�tion al ihe property address referenced above, if <br />ihe lotal cost of lhe inslallation is �reater than Ihe rebale <br />2. I, lhe Vendor, am a Vlas;-inglon State licensed contraclor. <br />3. Thc Cily n( [verett will send a Pedenl Form 1099 MISC lo mc, the Vendor, for Rackara�er <br />f�revention Device rehale paymenls lolaling more than ifi00 per calendar year, and will <br />report Ihe samc pay�r nts to ihe Inlemai Revemie Service. <br />1 accepl Ihc paymenl of lhe Rackwaler Pievenlion Device rebale from the City of Fvr.relt pending <br />approvai of the compinted Backwater Prevenlion Device reUate packac�e by ���e City of [vr,rell <br />�� __-__-�� - -�-�-.-�-- - ---- _ _ � (��-(1� -- <br />Signalu� onUdclor ! �`��� <br />