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! <br /> . i <br /> � <br /> i <br /> � <br /> i <br /> � Contractor Section: . � <br /> � <br /> � ---— '� ',--`�' . ' � j— -�—' '-��� . <br /> 1_+'�'r`�.('f�-t�--�i'_�C.�-�� f [�t-t L.I.,L c -'= ; <br /> Vendor Name I f3usino s Name I UBI Number � <br /> Q i <br /> �'i-l--l-�-df1,•�-�.�—.7�''�-�-� -'---- — ! <br /> Slale of Washington Gontrac!or License Number. � <br /> � <br /> �_��( L—�r1ii'�__Q_P_,,—��'_�_1�'1�.`��_r'�-�G:�. � <br /> Vendor Mailing Hddress City Slate Zip <br /> �c��r�7'�rn�g� L_���c;_�:��_��:�_ ��J� �,L��__�c�r�__ � <br /> Phone Email � <br /> -- ' <br /> — ' <br /> I <br /> I, the Vendor, agree to receive the Backwaler Prevention Devir,e rebate dieck dire�tly for the ; <br /> instaflation at the above ieferenced property address. !3y agreeing lo receive !he rebale r.heck j <br /> direr.Hy, I agree to Ihe follov�ing: ; <br /> L The Backwaler Prevenlion Device rebate amounl will be deducted from the final invoice � <br /> given to lhe property o�vncr for the installalion at Ihe property address referenced abovc, if + <br /> i <br /> the tolal cost n(thc insfallalion is �realer ihan Ihe rebate , <br /> 2. I, the Vendor, am a Washington Sfate licensed coniractor. � <br /> 1 <br /> 3. The City of Everett�vill send a Pederal Form 1099 MISC to me,the Ve�dor, for Backwater I <br /> Prevenlion Device rehate paymenis totaling more than $600 per calendar year, and will � <br /> report the s.imc paymenfs to ihe Inlemal Revenue Service <br /> -- -- _ _ .___ _ _. I <br /> I ar.r.epl Ihe paymeN o(the Backvaaler Prevenlion Device rebale from the City of Cverell pending � <br /> apProval oi the cornpleled f3ackwater Prevention Uevir.e u�hale package by ih2 Gily of[verett � <br /> i <br /> � <br /> i <br /> 1 � <br /> ��'�.�.��_��� ------ -- �����--=-- ; <br /> Si�7naturc of Contractor Daie ! <br /> i <br /> 1 <br /> - -- — ----- - --- — -- -- — � <br /> I <br /> i <br /> i <br /> 1 <br /> � <br /> i <br /> • I <br /> � <br />