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Contractor Section: <br />� <br />�1/�oNo �/cs, �q G-r�? G+I3 d S <br />Vendcr Name / Business Name�bor <br />����s ,�3 z r <br />5tale of Washinglo�i Contractor License Number: <br />�L�/`" J#ve�__a!� Ma�sv�.ra �„r9' �.�U <br />Vendor Maiiing Addre5s Cily State Zip <br />3F17- /.So7 <br />Phone Email <br />l, lhe V�ndor, egree to receive !he Backwat=; Prevenlion Oevice rc�+^'� check direclly for Ihe <br />installalion at the above re(erenced properry address. By agreeing to .�ewe the �ebale check <br />directly, I agree to the %Ilnwing: <br />1. The Bacicwator Prevention Devic� rebale amouni wili be dcduoled from the tinal invoice <br />given to the.property owner for tho installallon at the property address referenced nbove, it <br />the total cost ot the in6tallatiomis grcater Ihan the rebate. <br />2!, th9 Vendot,.am a Washinglon State Ilcensed conlractor. <br />3. The Cily oI Everetl will.send a Feder�l Form 1099 ��II5C W me, thc Vendor, for Backwaler <br />Prevention Device rebate payments totalmg�more ihen $600 percalend�r year, and w�il <br />report the samc payments to the Internal Revenue Service. <br />1 accept the payment of the Backwaler Prevention Dr�vice rebate from tlti� City of Everett pending <br />approv�il ot ihe cvmpleted Bnck�vater Prevemion bevfr.e rebale package by the C�ty of [verelt <br />Signature o( Conlrador <br />9%�/!,S'�� <br />Date <br />