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� <br /> � <br /> , <br /> � <br /> ; <br /> � <br /> � <br /> i <br /> Con4ractor Section: j <br /> I <br /> -- — � � j <br /> �C'w��r �-r I�V�(11�, I-�-� t�p�:� �5�7 Q <br /> Vendor Name/ Business Name/ UBI Number � � <br /> i <br /> �w�r F I—`�I ly m� � <br /> Slate of Washinglon Contractor License Number: <br /> � ' ��r• i f C�:'� . <br /> �(,� �`�,�� ��I � L� I?1r��(,�CL�, ltig ��v4�> ; <br /> Vendor Mailing Address Ciry State Zip + <br /> vee �"�e�-- 7�.-� s� , ���i��C�:w�r�}- ;��t� �y,��>�, ; <br /> � , <br /> Phone Email . <br /> � <br /> I, the Vendor, agree to receive lhe Backwater Preventic,n Device rebale check directly for the <br /> installation at the above referenced property address. By agreeing to recewe the rehate check <br /> diredly, 1 agree lo Ihe follov+ing: i <br /> 1. The Backwater Preven;ion Device rebale amount will he deducted from lhe 5nal invoice <br /> given to the property owner for the installation at Ihe property address referenced above, if <br /> the total wst of the inslallalion is greater fhan the rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractoc � <br /> 3. Tha City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate payments totalin� more than �600 per calendar year, and will j <br /> report the same paymenls lo the Internal Revenue Service. _ <br /> - -- I <br /> I accept the payment of the Backwater Prevention Device rebate from ihe Ciry of Everett pendiny <br /> approval of ibe compleled Backwater Prevention Device rebate package by the City of Everett � <br /> i <br /> 3 <br /> i <br /> i <br /> ��l�.�� ���-� � lr 1��� : <br /> Signature of Contractor Date 4 <br /> - -- —- ' <br /> � <br /> < , - a u:a ro ra i?� � <br /> �-�; ._a •� , r 1' �`.'�f'1�t � � <br /> °,�;. 'n'� ,� �;�,�, �{ g � �ram � <br /> �� �y �� [2 o <br /> ---}`' � �.er.��;Uv�s��_�`P���y4�'td�'�isi���""�� . .t;� �r,. ... . <br />