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- - _ -- - - <br /> � <br /> ' i <br /> � <br /> � <br /> ' Contractor Section: <br /> �}L1¢p R;,.v�6�N(, ���c- rcD3 �2S 6!(0 ; <br /> Vendor Name I Business Name!UBI Number , <br /> 1�e�9P��G 3 N 1- <br /> State of Washington Coniractor License Number: <br /> i O 60� 438`7 Sr.�oa orn�saG wv�_9�2�_ <br /> Vendor Mailing Address City State Zip <br /> i <br /> �� � <br /> � :711Co -gFIla-CJ9ZS �'�fc+rtCoil�Prs b S�i9N,� .co,•• <br /> � Phone Email � <br /> � <br /> II _ <br /> ; I, lhe Vendor, agree to reccive the Backwater Prevention Device rebate check direclly for the <br /> � inslallalion at Ihe above referenced property address. By agreeing to receive Ihe rebafe check <br /> � directly, I agree to the following: <br /> � 1. The BackH-ater Prr.ventinn Device rebatr, amounl will be deducled from the tinal mvoice <br /> given to lhe property owner for Ihe installation at the propeMy address reterenced above, if <br /> the total cost of 1he installation Is greater than Ihe mbate. � <br /> 2. I, the Vendor,am a Washingfon State licensed contraclor. 1 <br /> 3. The City of Gverell will send� Fedcral For;� 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate payments totaling more Ihan 5600 per calendar year, and wiil <br /> Ireport lhe same payments to lhe inlemal Revenue Service. <br /> � ---- — - � <br /> I accepl Ihe paymenf of lhe Backwater Prevention Device rebale from Ihe Cdy o(Evereri pending <br /> i approval of�he completed Backwaler Prevenlion Devico rebale p�r.kac�e hy Ihe City of Everett <br /> c �"J7� � 2_2'3 - (� <br /> ISignalure of Conhaclor Date <br /> � _ _ ___ - ---- ----- - — <br /> i <br /> i <br /> � _ .. _ <br />