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Contractor 5ection: <br />/ir;.��f%�G���[1/v (��> —�i > —GSSJ� <br />Vendor Name r' Business Name / UBI Numbar <br />�1.�i � �-' Gj C^� ----- - <br />Sfate of Washington Contractor License Numbr,r: <br />S`/G7 7_!=r/¢� NL, M/��' �'i1.�i� lNA 5� � a_ <br />Vendor Aqailing Address Cily State Zio <br />L�i.�Z-�� '-1.�G � _ <br />Phone ' Email <br />I, the Vendor, agree ro recaive !he Backwater Prevention Uevice rebals check direcfly for lhe <br />ir�sialiaGon at th� abova referenced property address. [3y agrc-eing lo receive the rebate check <br />alre :tly, I agree m ihe tolloe�ing <br />1 <br />:'.. <br />3. <br />� <br />The Back�vater Prevan;ion Dcvic� rebale amount �vill be deducted irom l�c ��nal irncice <br />given to lhe prcperty o�vner! 'he in_tallation at the property address re(erenc^_d above, ii <br />lhe toI21 cost oi fhe inslallatlon Is areater than the robate. <br />I, the Vendor, am a Washirgton State lir:nsed coMraclor, <br />The Cily of Everott ivill send a Federol �orm 1099 MISC lo me, lhe Vondor, for Rackwater <br />Prevenlion Device rebale payments totating more than 860U per catendar year, and e�ill <br />reporl ll,e same paymants to ihe Internal Revenue Service. <br />I accopt lhe oayment of ihe �ac4vrafer Pieventlon Device rebale irom the Clty oi Fverelt pending <br />approval of the comnleted Backaater Preveniion Devica rebale packac�e by the Cily oi Everett <br />�. <br />;•_. <br />Signature of Conlrar.tor �� <br />4�_ __-L� <br />Date <br />