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il i <br /> � I <br /> ' Contractor Section: I <br /> h <br /> � -- ---- — -- -- -- <br /> ' ��o�,, P��,�-,!, r ���� ��� <br /> Vendor Name!Business�me! UBI Number <br /> � <br /> I�; � I /`'� u� n/� � ��3 ,T � � � ' ' <br /> Y I I <br /> � State o(V�'ashington Contractor License Number. � II <br /> i ; ; � � 7� 5 .:� t-!f� S�. S� . SYwlf.,�.-.t� l.� ci Z� �U � ! <br /> i Vendor Mailing Address City State Zip • <br /> � <br /> I <br /> I c. 2 � 760 �SL� "��-c,��" � i"r�er /�lti v..l,•a�/. �� ,� <br /> Phone Email '—T � '{ <br /> � ` , <br /> ; , '; . •;� <br /> It I, the Vendor agree to receive the BackwaterPrevention Device rebate check directly for Ihe ' <br /> I � ,� installalion at the above re(erenced property address. By agreeing to receiDz the rebate check <br /> ,f ` directly;I agree to lhe folloviing: � ' <br /> ! '� 1. The Backwater Prevention Device rebate amount will be deducted �rom the Fn�l invcice <br /> "' given to the property owner for the in`stallation aj the property address referenced above, if <br /> �� lhe total cost oi the installation is greater lhan the rebate. <br /> Yt . � <br /> 2. I, ttie.Ve�dor,.am a VJashington State hcensed conlractor. � <br /> I � 3. The City of[vere(t v�ill send a Fede�ai Form 1099 MISC to me,�flie Vendor, (or Backvrater <br /> � ' Prevention Device rebate payments totaling more than 5600 per calendar year, and will <br /> � report tfie same payments lo the Intetnal Revenue Service. <br /> � — _— - -�'-� —.. . - � <br /> � I accepl ihe payment of tfie Back�vater Prevention Device rebate irom the City of Everoit pending <br /> approval of the compfeted Backwater Prevention Device rebale package tiy the City of Everett <br /> I ,, <br /> I'�� � <br /> , � � �, �-f � - � S . ; <br /> i - <br /> I SignaWre of Contraclor Date <br /> i <br /> i <br /> I <br /> �! <br /> - -- � - ---..- - _ .-- -- -- -. _. _--..— �----. . ._--- - � - ---_—__- -- - ----�- �� - - - -- --. .. -- <br /> I---. _ ."_ .. . <br />