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OCT-23-2015 0°�Z0 From:14253770629 <br />CORtP8Cl0!' SEC4EOh: <br />��-C —� c�c� <br />Vendor NAme I Business Name /iU81 Number <br />5'� 8C <br />raee:�'� <br />�Y� 1-- � � �.0 h� �j <br />Sfate of Washington ConVactor License Number. <br />�� �X .�'I � L�IYI'�li�xX,r. �V� `��4Cn <br />Vendar Mailing Address <br />Email <br />Ciry Sfate Zip <br />?5ewer-�r i��d ly,�a m <br />I, the Vendo�, 2Brea to re�ive the Rackw2ter Proverttlon Devi� rehate chsek directiy fortre <br />installatiDn at the abovo ref�erced pioperty aAdress. 8y agrceing lo receive the rebate check <br />dhectly, I agree W the fultcwing; <br />2. <br />3. <br />1'ho Becicwater P[evention Gevtce rebate amalrtt wi�� be deducted fm n the firtal jnvoice <br />given to riie property ownerfor 1he installaUon at the proporty address roferenced above, if <br />the lotat co�t cF ths Insfaftation is c}reater than the tohate. <br />I, lfie Vendor, am a Washingta� State licensed contractor. <br />The C'rty of Everen wlll send a Fedasal Fortn 1099 ti11SC ta me, ihe Vendor, for Bacloaeter <br />Prevantion Devlce rebate paymerrts totalinp more than SB00 per catendar yeaz. and will <br />repoR the s3me payments to Ne Iniamal Revenue Service. <br />1 accept the payment of ihe 6ackweter preyontlon Oevlce robate frnm the City of EverelCpendin0 <br />approvai of lhe camplete6 8ackwater ProvanHon Device r�bate packege by the Ciry of Everett <br />���'�,,��-- �-��—��-�' ►� — Z3 —� 5 — <br />Slgnaturv of Contrtaatot Dato <br />