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i <br /> l <br /> � <br /> I <br /> , <br /> � <br />�;;�, :���. i <br /> { <br /> � <br /> Contractor Sectiorr. j <br /> � <br /> CJ'S PLUMBING 8 SERVICE LlC I Fi02 950 11� � <br /> Vendor Name I 8usiness Name/UBI Number ` <br /> GSPLPS91 W D , <br /> 1 <br /> State o(Washinglon Conlractor License Number: � <br /> I <br /> 5528 218TH AV[N[ Gf2ANITE FALLS WA 98252 , <br /> Vendor Mailing Address Cily State Zip � <br /> i <br /> 360-691-5159 CJSPLUMBING@MSN.COM ( <br /> Phono Email � <br /> ,—.-- I <br /> i <br /> I,the Vendor, agree ro receive lhe Backwater Prevention Device robate check direclly for the <br /> installalion at the above referenced property address. By agreeinc�to receive the rebato check <br /> directly, I agree to Ihe following <br /> L The Back�vater Prevention Device rebale amount wdI be deducled from ihe final invoice <br /> given to the property owner for lhe installation al the property address refcrenced above,d <br /> the lotal cost ol lhe instailation is groaler Ihan the rebate. <br /> 2. I, lhe Vendor, am a Washinglon Slate licensed conlractor, <br /> 3. ?he City of Evcrett will send a Federal Form 1099 MISC to me.Ihe Vendor, lor 8ackwater <br /> Prevenlion Device rebate paymenls tolaling more than 5G00 per calendar year, and wlll <br /> report lhe same paymenls lo the Inlcrnal Revenue Service. <br /> I accepl Ihe paymont ol the Backwaler Prevenlion Device rebale trom th�i City o(Evorott pendinr� <br /> approval ot Ihe compteled Backwaler Prcvention �evice rebale package by lhe City of Everetl <br /> ` o�- t�'-1� <br /> i�nature of Contr o Date <br />