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Contra�tor Sect4or�: <br />/�r�11,�L����tr_�cr (�.> �-�>' � �cvS�' <br />Vendor Name / Business Name / UBI Number <br />� <br />T I'fi% � ��� ,�G�.? C-1 <br />State of Washington Coniracfor License Number: <br />..�`��.i ��/� �..�'✓�_ /V�_ �/.�,�� �.� i�.��,,,,.��' �lV.� 7'��._,��- <br />Vendor Mailing Address City State Zip <br />r��r�.s� ��� �-�.��� <br />Phane ` Email .._.._. __. _ <br />I, the Vendor, agree to receive the Back�h�ater Prevention Qevice rebate cneck directly iar fhe <br />installation at the a�ove referenced proper'ty eddress. F3y agrseing to receive the rebate check <br />directly, I agree to the folla�ving: <br />1, The BacE�vater Prevention Device rebate amount will be deducted firam the final invoice <br />given to the properiy o�vner for the installation at �he property address referenced above, ii <br />ths to�al cost of the insta{lation is greater than the rebate. <br />2. I, the Vendor, am a�Nashington Statz lic�nsed contractor. <br />3. The City of Everett wi!{ send a Federal FQrm 1099 MISC to me, the Vendor, for Bacic�f�ater <br />Prevention Qevice rebate payments totaling more tnan �600 p�r cal�ndar year, and tvill <br />report the same payments to the Internal Rpvenue Service. <br />1 acc�pt the payment of the Backwater Prevention Device rebate from the Gity of �verett pending <br />approval of th� completed Back�vater Prevention Device rebat� package by the City of Evereii <br />�.�.. _.�-'' � ��;� _ �-� --- � .� <br />Signature af Contractor D�te <br />