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; <br /> i <br /> i <br /> Contractor Section: . � <br /> -- � <br /> � <br /> ' � i-G:L��Q—�' CC'�-�-u-�-�-�—��� 'LL � I-�.(� _�>U'-��"L'y'�:3 i� � <br /> � <br /> Vendor Nama I Busin�ame I UBI Number j <br /> � <br /> �_���':.z.�,`�-�-�'�---�-�-- <br /> State of Washington Contractor License Number. ; <br /> i <br /> ��(�._��c_1.i�1—QP_,_ --�f��-r�-1�c�a ��'�c%� � <br /> Vendor Ulailing Address Ciry State Zip � <br /> � <br /> �, ,r�-�:��;��a �����r�_��_��. �,.._��L�c�,_c�r'�__ ` <br /> Phone Email i <br /> ! <br /> I <br /> — - i <br /> I, the Vendor, ayree to receive lhe Rar,kwaler Prevention Uevice rebate check direcUy for Ihe � <br /> installation at Ihe a6ove referenced property address. Dy agreeing to receive the rebale check ; <br /> direr,tly, I agree to the foliowing: ' <br /> 1. The Backwater Prevention Device rebate amounl will be deducted trom the final invoice j <br /> given fo the oroperty owner for the installation at the property address refcrenced above, iF � <br /> the lotnl cost o(the install�lion is greater than the rebate , <br /> 2. I, the Vendor, am a Washington Stc�le licensed rontractor. <br /> 3. The Cily of Fvrretl will send a Pederal Form 1099 h4iSC lo mc, the Vr.ndor, tor Backv�ater <br /> Prevention Device rebate payments totaling more than $600 per caiendar year, �nd will { <br /> report the same pay:�enls to the I�lernal Revenue Service i <br /> f <br /> — ---- ' <br /> I accopl thu paymenl of thr. Backwaler Prevention Device rebate frum Ihe Cily of Lveretl pendin� � <br /> approval of the completed B2ckw2ter Pr�venlion Device rehate package by Ihe City oi Everell <br /> i <br /> i <br /> .�� � � � �PL��(S_ ! <br /> �---' �F-=-�"- --- -- - ---- i <br /> SignaWre of Contractor Datc i <br /> 1 <br /> t <br /> — - _—_ <br /> ------------ a <br /> �----- ._------� �--- I <br /> . _. __.._..._ ' <br /> i <br /> i <br /> { <br />