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Contractor Section: <br /> �?"�"���b�1�'��-(._C.C._�i��.S�-'�_v_a� �OG� Z-r'/l -�-"7 3 <br /> Vendor Name/ BusineS�SName/UBI Num6er <br /> —�'����� - - - - <br /> State of Washinglon Contractor License Number. , <br /> � _ g6 ��_JLC.�S�r�i�' -�91/�___�'� wY9-- �.��_ <br /> VendorMailingAddress . r ,, . Cit�,'-. •� 'State Zip <br /> � . <br /> � �- a �-�-���z� __�-�-pi:���,���,Jc�� . � �-c��- <br /> IPhone Email <br /> L- _ <br /> I, the Vend�q ag�e b,recBiMce the Backw�te�Yrovqplion�;e�i�e�reba(e aher�direclly�for the <br /> inslallatioii al lhe above relerenced property address. By agreemg�o receive the re6ate cfieck <br /> direclly, I agrae to the.follo'vufig:�; '� <br /> _ . � • r . <br /> 1. The Backwater Prevention Device rebate amount will 6e deducted(rom the fi�al invoice <br /> given to the property owner(or the installation at ihe property addre=s referenr.ed above, if <br /> the lolal r.osi of the mstallation is greater than lhe rebate <br /> 2. I, lhe Vendor, 2m a Washington State licensed contractor. <br /> 3. The City of Everelt will send a Federal Form 1099 MISC to me, Uie Vendor, for Bar.k�+�ater <br /> Prevention Device rebate paymenls totaling more ihan 5600 per cale.ndar year, and will <br /> report the same paymen�s to lhe Inlcmal Revenue Service <br /> � - --- --------- - --- - - - i <br /> iI accepl the payment of the Back�valer Prevenfion Device rebale from lhe City of Evereft pending i <br /> approval of ihe cornpleted Backv✓aler Prevenlion ;�evice rebale package by the City o� Everett <br /> � � <br /> , , ' <br /> ._ _�l.� � <br /> Sigqature of Conirac`or . Dale <br /> 3 - _ _ _ . _- _ . _ , _ _._ _-__ .. .___ _ _ I <br />