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i <br /> i <br /> I <br /> Contractor S�ction: � <br /> _ _ � <br /> --- - __ — <br /> __ . -- -- - <br /> I ---- - ` f � � �. �,�-, Ll � -- fc>�;�• J�`t�3 � <br /> �'�4'1'1�,'(�tCLL-1�-- .�L.'�-- -tC-_�k �lf C S'�_,_�E:�t., : <br /> Vendo� Name/�usineSs Name I UBI Number ; <br /> I <br /> � !vl- � FiZ .`.7,`,> �-�' �– �-� - - <br /> �tate of Washington Contractor I.ir,ense Numbef: ' <br /> �ls��_Cfl-- -LclC.lil'1—L� P,._ ��'�CP.'i� (,[.`�<__r'��Ci,3 � <br /> Vendor Mailiny Address City State �ip , <br /> o'�c��',�� -,�1�"���4� _ L�'�►�r.l� Ci c�__��.� cJ•�c��.��C��_Ct_��'J? ; <br /> Phone Finail <br /> � <br /> i — -- -- _ <br /> I, Ihe Vendor, ayree to receivr the Rackwater Prevention Device rehate r.heck direclly tor Ihe ; <br /> inslallation at Ihe ahnve rr.ferenced property addrr.ss. Dy agreeing to !ecr.ivr Ihe rebale r.hr.ck <br /> dirr.r.tly, I agree to Ihn (ollowing: � <br /> 1. lhe 8ar.kwater Prevention Oovice rebale amounl�ntl bi� doduclr,d from the fin�al invoice <br /> given lo Ifv� propr.rty owner tor lhe ir.stollatian at the pro„e�+y address refcrenced abovr., if <br /> �he lotal r.nst oi the inslallahon is greater Ihan Ihe rrbate i I <br /> i <br /> Z. I, Ihe Vendor, ��m a Washington Slatr. lir.ensod r,�Mrer.lor. <br /> 3 1 hr. City of Fvciett will send n fed��ral Form 1099 MISC to me, Ihr. Vendor. for 8ar.kwatcr <br /> I'rew�nlion DevicF rebale paymenls lotalin�� more Q�an $600 p�ar ralendai year, and will � <br /> «:port the samr paymen�s to Ihe Internal Revenue Service <br /> I I acr.epl �lie payrnent u1 lhe k3ackv�al�:r Pn,v��nlion IJevice rnhat� linm the City nf f_verett pendinp � <br /> approvni of the r.nmplr:ted f�ar,kv�ater P�ev�:nhun Dcvir.e rebate par.k;igc hy �hc Cdy ul 1=.veicll <br /> � <br /> �� l_' ) ��— — — - ����!'I�.�__ <br /> �-�-1��-- . y-r"i�-_.. � <br /> Signature of Gunlractor Date , <br /> -- — -- — — -- — — <br /> ---- __ - -- - -- — 1 <br /> � <br /> � <br />