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Contractor 5ection: <br />�b������5�"�1_ � ll�.�����f. b� �l6�_� I � -- il <br />Vendor Name / Busine s Name / UBI Number � <br />S�C� � �5 � �3_Y-1� --- - - - <br />State of Washington Contraclor License Number. <br />P• 0.14J�� m,Ul�l ���_ ���'15__ , <br />Vendor Ntailing Addtess City State Zip i <br />�i�-�1�]� '�ii7ll _ e4s��' L's1'1`�Cl'_ U��1�Y1_A,1,}�Y'�1�� ���� I <br />Phoi e �Email U I <br />I, tne Vendor, agree to receive the Badof�ater Prevention Device rebate check directly for Ihe <br />installation at the above reterenced property address By aareeing to receive the rebate check <br />d�rectly, I agree to the follovnng�. <br />ra <br />t. The Back�valer Prevention Device rebate amount vfill be deducted trom the final invoice <br />given to ihe property o�nner for Ihe installalion at Ihe praperly address ra(erenced abovc, if <br />the total cost o( the inslallalion is grealer ihan the rebate. <br />2. I, the Vendor, �m a Wash ngton Sta�e �icensed contraclor. <br />The Ciry ol Everett will send a Federal Form 7099 DAISC to me, ih� Vendor, for Bacicc�ater <br />Prevention Device rehate payments totalinq more than $600 per calendar year, and vii!I <br />repart lhe same paymen�s to the Inlemal Revenuc Service. <br />I acr,epl ihe paymenl ol the Backvialer Prevention Device rebate Irom tne C�;y of Everett pendinp <br />approv2l of ihe completed Dackv�ater Prevention Uevice rebaie package by �he City o� Everett <br />- � ���J-� -- <br />Sign�t�e t nirk or <br />i \ <br />��- '-.1'-�`�\�_ <br />Date <br />