Laserfiche WebLink
i <br /> . ; <br /> ! <br /> ; <br /> I <br /> i <br /> � <br /> � Contractor Section: . � <br /> _----------------- -- <br /> i <br /> _ � <br /> i <br /> ` �tG�-•j1�f'.=.—����CU�''' '�-�`9"`—�',' <br /> �-e11��''-��Y-�-�' •- - j <br /> Vendor Name/Busine..s Name! U81 Number � <br /> i <br /> ��'1��z��-��- �-�'- -- - - ; <br /> Stale of Washin�ton Contraclor License Nunber: � <br /> � <br /> _��( Lc�.r_�i►��_R�_�N�-c�'_�_��s�, ;� G� ; <br /> Vendor Mailing Address City State ZiP ( <br /> � <br /> /� ; <br /> 'a��_�Lg��'c►�-'+�C1S:L'._.o?��_ �'J-�Ct.1'10��_l'—ot_'1�-- i <br /> Phone Email I <br /> i <br /> __ -- � <br /> I,the Vendor, agree io receive lhe Backwaler Prevention Device rebale check directly tor the � <br /> installation al ihe ahove referenced properly address. By agreeing to roceive lhe rebafe check � <br /> directly, I agree fo the tollowing: � <br /> � <br /> i <br /> 1. The Backwaler Prevenlion Device rebaio amount will be deducted from the final invoice ', <br /> given to the property owner for ihc installalion at the properly address referenced abovo, if � <br /> ihe to�af cost of the inslallation is greater(han the rebate. } <br /> 2. 1, the Vendor, am a Washinglon St�te licensed contractor. � <br /> 3. The Cily of Everett will send a Federal Form 1099 MISC to me,the Vendor, (or Backwater ` <br /> Prevention Device rebate payments totaling more than$600 per calendar year,and will ! <br /> report the same payments to ihe Intemal Revenuc Service. � <br /> _ .— — - --- ------ — --�� � <br /> I accepl thr, p�yment oF the Backviater Prevenlion Device rebate from the Ciry of Everett pending i <br /> apUroval of fhe completed Backwater Preverdion Device rebate par.kage by the Ciry of Fverett � <br /> i <br /> � <br /> i � <br /> C���_-�.�� - -- - -����s--- j <br /> SignaWre of Contractor Date , <br /> i <br /> __. � <br /> _ --- —_ _- - — � <br /> i <br /> � <br /> i <br /> i <br /> � <br /> ! <br /> . � <br /> l <br /> �. <br />