Laserfiche WebLink
1 <br /> I <br /> I <br /> I Contractor Section: <br /> i - --- --- — <br /> i pb��.cz 603 � a gs- ll'� -- -- <br /> � Vendor Name/Business Name/UBI Number <br /> � �t7soI5S ��'1�� <br /> Slate of Washington Contrac or License Number: <br /> � o� �?��f� S'�':S(,J• �dycvo s lit)6� 1���� <br /> Vendor Mailing Address City State 2ip <br /> � a�- ' 6 s - I 3 .so�u-�es�az���se�� C�Ma; <br /> Phone Email <br /> , '__ <br /> � <br /> j I, lhe Vendor, agree to receive the Bac6water Prevenlion Device rebate check diredly for the <br /> i installalion at the above re(erenced property address. By agreeing to receive the rebale check <br /> directly, I agree to the following: <br /> i, <br /> 1. The Backwater Prevention Device rebate amount will be deducted irom the final invoice <br /> ; given to ihe property owner for the installation at the property address referenced above, if <br /> the total cost of the installation is greale�lhan the rebate. <br /> 2. I, Ihe Vendor, am a Washington State licensed contraclor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> � Prevention Device rebate payments tolaling more than$600 per cal=ndar year, and will <br /> report lhe same payments to thc Intemal Revenue Service. <br /> i <br /> I accepl Ihe payment of the Backwater Prevention Device rebate from ihe City ot Everett pending <br /> Iapprovat o(the completed Backwater Prevention Device rebate package by lhe City ol Everett <br /> �f <br /> ���.C��� I � - g-��y <br /> i ignaWre of Contractor Date <br /> i <br /> I <br /> � <br /> �I <br />