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Contractor Sec6on: <br />�r • <br />t,�.�1'�T_t�. i�.�1�U��.-f—�` . ur�n _��L(�.,.G�oz.-���-1� <br />Vend�r Name � Auslness IVama! UBI Num �r <br />_� _ �����.�� �. � - -�-� �u /�'��/ /� <br />Sfal� ef�ashingtoi7 Cab�or licon. Number. <br />� �'L.._l./� �t._��z. ��,1� _. tit" ���7" l,, �- �d� �v <br />VPndor Matling Address Ci►y Slate Zip <br />�yz �= �J�� -a�z � <br />Phane <br />- ������,��vt pLL.(�: <br />�rnad .J <br />�. lh� Vetidor, a��ea It� rece�ue ll�e gackrratar Preventian Clevice rebale check direrlly (or Ihe <br />mslullaGe�� ai the a6nve reterencod ptoWedy address By ogmcmg i4 mceive U+e re6ate check <br />tlireetly. ! agrea to ihe (ollar�ing= <br />1 Tha Brtckwaiet Prevenhnn Ucvrce rebate nmount will he dedncted Gvm tha final invoict <br />groen lo Ihe p:o�eriy o�tiTer lo� I!Sc inslallahnn :�1 lhe R�Periy 7�'dress re�eren�e�i ebwn, d <br />Ihe tr�t:il cc�st ot th� msta�iallan �s flreaier than thE rebal�. <br />2 1, llk Vendar: rm a Wast�lnfli�vi Slaio 4censarl canlracler, <br />3 ThF� City o1 Everglt wiq sFnr1 a �CdGrat F�rm i099 tJ115� to m�i, iha Vendo4 irn FSar.I:walrf <br />prr�ventian bov�c� ��6aie (�ayrtn„nt5 toialmg mure ihan 56�D per calen�ar ye�r, and vriil <br />r�pnd iho somn paym.�r;�, te tha Intem.�t RRveRua Sere,co. <br />i uc�ept the p�ymc�u o( du� ps�5:valcr ProvenLon U�vica rrebaie frairt �hu Cily ai �vereti ponding <br />appravnl aF Ihu compl��i�d Lle� Fs�:rl�_r Pr�vcnpan l3evic+] ret��tu pack,�r�u 6y tttu Cify oT Eaercit <br />. <br />, <br />1 <br />- _ .�_��� <br />SignJ , o1'Ct}R�filLlbr <br />_.� *.�� j �.� <br />��w <br />� <br />�l <br />