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I <br /> � <br /> � <br /> i <br /> , <br /> i <br /> { <br /> C�ntractor Section: � <br /> -- — __ ___ ---------- i <br /> (D P/�b% „�I� -- � <br /> Ve dor Dlama 18uslness Name/U81 Number ; <br /> f�o F'L 903�� � <br /> Stale of Wasnington Contractor License Number: ' <br /> A�IIo_i�'�.�k,I�, y0� 7!�/'A�c Il2E �'�;,�IIP !e��`'��7�— ' <br /> Vendor Mai mo Address City Stote Zip ` <br /> i <br /> `/Z 5-�7-I So7 � <br /> i <br /> Phone Email ; <br /> i <br /> I <br /> — i <br /> I,lhe Vendor,agree to receive the Backwaler Prevenfion Device rebate check directly for the j <br /> installation at the above referenced propzrty address. By agreeing to receive the rebale check <br /> directly, I agree to the following: f <br /> t. The Backwater Prevenlion Device rebate amount will be deducted from the final invoice <br /> given lo the properry owner for the installalion at the property address re(erenced above, il <br /> the lolal cost of the installation is greater Ihan the rebate. <br /> 2 I, Ihe Vendor, am a Washinglon Stafe licensed contractor. ; <br /> 3 The Cily of EvereU will send a Federal Form 1099 MISC to me, Ihe Vendor, for Backwater � <br /> Prevenlion Device rebate payments totaiing more than 5600 per calendar year, and wlll ; <br /> report the samc payments to lhe Internal Revenue Servlce. � <br /> � <br /> --- -- --- ---- _ __ � <br /> I accepl lhe payment of the Backwater Prevention Device rebate from the City of Eve�elt pending I <br /> approv�l of Ihe compleled Backwater Prevention Device rebate package by the City oi EvereR � <br /> i <br /> � <br /> �'_���� 6 �/ZoiS ' <br /> ,�. ,;;- � <br /> Sigp� � , � 7.�nractor �ate ! <br /> y�� -- -- - ------ -- - - ' <br /> - � <br /> � <br /> ; <br /> ; <br /> � <br /> � <br />