Laserfiche WebLink
Contractor Section: <br />I <br />�'�W�t''iP.�--�k �f., .1_d�, �t��.c�_L-Lc% _�.�`�1_�h�':3I <br />Vendor Name ! Busine s Name 1 UBI Number I <br />n f i <br />�1���'-1Z..1-.��._ ,''�w-'—.+-i-N — — -- � <br />State of Washington Cantraclor License Number. <br />Vendor �Aailing Address <br />Phone <br />Email <br />City State ZiP <br />��� . c'd' L�1�G�?t_;5��- <br />I, the Vendor, agree to receive ihe Backwater Pravention Device rebate check directly for lhe <br />installation at the above re(erenced property address. By acareeing to receive the rebate check <br />oirectly, I agree to the (ollowing: <br />1. The Backv�ater Prevention Device rebate amount wiil be deducted from the 5nal invoice <br />given to the property owner for lhe installation at lhe property address referenced above, if <br />the total cost of ihe lnstallation is greater tnan Ihe rebate. <br />RJ <br />I, the Vendor, am a Washington Stato licensed contracfor. <br />The City of Everett v,i11 send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totating more than $600 per calendar year, and will <br />report the same payments to ihe Intemal P.evenue Service. <br />I accepl the paYmenl of lhe Backv�ater Prevention Device rebate from the City of Everelt pendiny <br />approval of the completed 6ackwater Prevention Device rebate package by the City of EvereU <br />/' <br />� �� ��� <�: -- <br />SignaWre of Contraclor <br />�-�I���-- <br />Date <br />