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Cohtractor Section: <br />�lendor Name 1 Busine�s Name / UBI Number <br />_gi`��.—l'�L�-���1_'>�— <br />State of Washington Contractor License Number. <br />��'l� Lc��.�i�i—iJ $.�___ '' �'�-1�_, �ir �'.�_a?G_3 <br />V:�ndor Mailing Address Ciry State ZiP <br />Phone Email <br />i, the Vendnr, agree io receive the Back�vater Prevention Device rebale check directly for the <br />installation at the above referenced properly address. dy agreeing to receive ihe rebate check <br />directly, I agree to the following: <br />1. The Back�vater Prevention Device rebale amount will be deducled from ihe finai invoice <br />given lo the propeiiy owner for the installalion at the property address referenced above, iF <br />the lotal cost of the installation is greafer Ihan the rebale. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The Ciry of Everetl �viil send a Federal Form 1099 MISC to mc, the Vendor, tor Backwater <br />Prevention Devico rebate payments totaling more than $600 por calendar year, and will <br />report ihe same paymenls lo the INcrnai Revenue Scrvice <br />I accepl the paymenl o( the Backv✓ater Prevention Device rebate from the City of [verelt pending <br />approval of the completed Backwater Preveniion Devir,e rebate package by the Cily oi [veretl <br />/ 1 <br />l�f�'���' —_ �c—G—_�� — <br />Signature of Contractor <br />� <br />_1� �� ���s — <br />Uale <br />