Laserfiche WebLink
Confiractor S�ec#ion: <br />��t��'.� ���������t iL-� <br />Vendor Name / Business Name� UBI Nurnher <br />�`� C� t�o^ � � � �j `�' � i� <br />State of Washingion Contractar License Number: <br />�� ._ �-((�3�- �C;`'i <br />i%;� (� �-{ I'�� Sd � `�j,�r �� c� s�, t� t �s L��t-�- `=� b''Z�`'-� tJ <br />Vandor Mailing Address City 5tate Zip <br />���� ��v � � <br />Phone <br />� <br />� : '-�{� � .� c� <br />Email <br />�r.�,:n �j �r�{� _ c:_.:, �~� <br />f, the Venclor, agree to receive the Backwater Prevenfiion Devfce rebate check directiy for the <br />insfallaiion at the above referenced property address. By agreeing ta receive the rebate che�k <br />diractly, ! agree to #he foliawing: <br />1. The Backwater Preveniion Device rebate amount wilf be deducted from the frnal in�oice <br />given to the property owner �or the installatian at the property address referenced above, if <br />the totaf cost of the installa#ion is greater than fhe rebate. <br />2. I, the Vendor, am a Washington State iicensed contractor. <br />3. The City of ��erett will send a Federal �orm 1 Q99 M]SC to me, the Vendor, for Backwater <br />Prevention Device rabate payments totaling mor� then $600 per calsndar year, and will <br />report the same paymants to th� Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Sackwater Preveniion Device rebate package by the Csty of EveretE <br />�` v ��-�---- <br />Signafu�e of Contractor <br />�,���"�� <br />Date <br />