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r,; <br /> ' I <br /> i <br /> I <br /> Contrac4or Section: ' <br /> I <br /> t <br /> Vendor Name!Business Name/UBI Number I <br /> John Pestell / Side�Sewerl ��L `f�� �� � ; <br /> � <br /> Stale of Washington Conhactor License Number: I <br /> SIDES**853K8 ; <br /> , <br /> Vendor Mailing Address Cily State Z.ip i <br /> P.O. Box 137 Mukilteo, Wa 98275 ' <br /> Phonc � 7 Email � <br /> � �s - 7 ���� r�� C� - ��.c�,�� ; <br /> � i- , <br /> I,the Vandor,agree to recoive the Backwater Preven6on evice r ate check directly tor the� � <br /> i <br /> inslallafion at thv above reterenced property address.By agreeing to receive ihe rebate check <br /> directly,I agree�o the following: � <br /> i <br /> 1. The Backwater Prevention Device reba[e amounl will be deducted lrom ihe final irnoice '� <br /> g'rven to Me property owner tor the instellation at tiie property address referenced above, if i <br /> the totai cost ol Ihe installation is greater than the rehate. ' <br /> 2. I,the Ventlor,am a Washington State licensed conlraclor. • � <br /> 3. ?hc City of Fveretl will send a I�ederal Form 1099 MISC fo me,the Vendor,tor Backwaler ' <br /> Prevention Device rebale payrtients tatali�g more Ihan$600 per calendar year,and will ; <br /> repoA Ihe same 4ayments lo the Intemal Revenae Service. � <br /> � <br /> I accept lhe paymenl of the Backwatec Pre�¢;dion Device rebate Irom the City oi Everett pending <br /> approval of the completed 8ackwater Prevenlion Device rebate package by ihe Ciry ot Everett � <br /> , <br /> 1 <br /> i <br /> - — - /_�_�_ �YS' I <br /> � nalure ol Irac r Dale ' <br /> I <br /> � <br /> - --- � <br /> � <br /> i <br /> ; <br /> i <br /> � <br /> . e + <br />