Laserfiche WebLink
-_ - <br /> ' < � � �_: ' � ' , <br /> , i � � , ;,' - <br /> < < ., <br /> , .. . ..,. . <br /> , <br /> " ' Contractor Section: 1 <br /> ,, , . <br /> �'�,,�s n�cLl���.`� , �--�i�.,�,�«, G�c �y � Z--��- , 3 <br /> Vendor Name/Business Name/ B�r � <br /> �9--H-P/� /�'� //r''/� _ <br /> State of Washington Contractor License Number. <br /> 8� �/ G�I�S'� l�:�����ts` i`)"1�" -ti.,-2'T L.�-)- �J'� d�, <br /> Vendor Mailing Address City State Zip <br /> ` ��z-I=l�� 9 - ��/ Z.3 T9r3- ,'l� ����� CL���/� inu--u. <br /> Phone Email <br /> I,the,Vendor, agree to receive ihe 9ackwator Prevention Device rebate check directly for the <br /> instaUa6on at lhe above re(erenced property address. By agreeing to receive Ne rebate checlC <br /> directly, 1 ag�ee lo the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invaice ` ' <br /> given to ihe property owner for the installation at ihe property address referenced atove, if <br /> the total cost of the instalialion is greater than lhe rebate. <br /> 2. . I, lhe Vendor,am a Washington State licensed contractor. . <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor,tor Backwater <br /> Prevenflon Device rebate payments totaling more than$600 per calendar year;and will <br /> report the same payments to the Internal Revenue Service. <br /> I accept Ihe paymant of the Backwater Prevention Device rebate irom(he City of Everett pending <br /> approval of the wmpleted Backwaler Prevention Device rebale package by lhe City of Everefl + <br /> -�.�= �7���_1 � . <br /> Signature oi Contractor . Date <br />