1814 COLBY AVE 2016-01-01 MF Import

i , � i i , Contractor Section: . 1i ! — --- ----� � ,(� �� , I I S•iW�N-«- � P � �L7('� LL.C: � C.}'� � �` � :a�.3 �S i n � , C � �t_c�._.--� •-;-- --��_L_�t_ Vendor Name I Busin�me/U81 Numbr,r � � i �1--1_��—�-`�— i State of Washington Contractor License Number. ' �lw��r lia—�-�,=—��_r�1�'�,��:��3 ; Vendor Mailing Address Ciry State Zip � { ar�-�-rn�a�s�_C��c�s�.:�.�� s onZ. � Plione Email I i � I,ihe Vendor, agree to receive lhe Backwater Prevention Device rebate check direclty for the I instailation al the above referenced property addross. By agreeing to rereive the rebate check � directly, I agree to tho following � 1. The Bacicvrater Prevention Device rebate amount will be deducled from the final invoice � given to lhe property owner for lhe installation at the property address referenced above, if ' the tolal cost of Ihe installation is greater than Ihe rebate. 2. I, the V�ndor, am a\Nashinglon State licensed contracloc � 3. The City ot [verett will send a Federal Form 1099 MISC to me,the Vendor,for Backwater � Prevention Device rebale payments totaling more than �600 per calendar year, and�vill report the same payments to the Intemal Revenue 5ervice. ; i -- -- — � I accepl the payment of the Backwater Prevenlion Device rebale from the City ot Everett pending � approval o(the cortipieted Backwater Prevention Device rebate package by lhe Ciry of Everelt i i ; (�`�.�...�-' C�� -gf-r�� i Signature of Contracror Date i � - � -- --- � i i i i i