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Contractor Section: <br /> � <br /> M oe.�� _�l�M � ti c� c7�(���r G ti�- <br /> Vendor Name I Business.�e I UBI Number <br /> ��1 a c.,� Pf%� �f�'3�,1 !� — <br /> State of Washinglon Contractor License Number: <br /> ��S� s �(rS'� v 5-r: S���o.��s� w'H ci�25U ' <br /> Vendor Mailing Address Cdy State Zip , <br /> ��S 7� ��O 'f��Cnf"�a n�czn�l�.r-.b��� . cor-- <br /> _ � <br /> Phone Email j <br /> I, the Vendor, agree to receive Uie Backwaler Prevention Dewce rebale chech duecily (or the <br /> ins[allation at the above re(erenced property address. 8y agreeing to receive the rebate check <br /> directiy, I agree to the following: <br /> 1. The Back�vater PrevenGon Device rebale amounl will be deducted from the tinai invoice <br /> given �o lhe property owner for the installaLornat the property address referenced a6ove, if <br /> the tolal cost of the installalion is qreater than the rebate. <br /> 2. I, the Venior, am a Washington State licensed conlractor. <br /> 3. The City o( EvereU will send a FeAeral•Form 1099 MISC to me, ihe Vendor,for Bar.kwater <br /> PrevenUomDevice rebale payments totaling mnre than 5600 per calendar year, and will <br /> report lhe same paymr.nts in Ihe Intemal Revenue Service <br /> I accept the payment of lhe �ackrvaler Prevenlion Device rebate from the City of[verelt pending <br /> approval of Ihe compleled Bachwaler Prevention Device rebale package by lhe City of Everett <br /> � � �� o�— �7� � s-- <br /> �Signature of Contractor Date <br /> --- --- — — — — — — <br />