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Contractor Section: <br />i�1i1�.L�C� l�ui✓lI'��NG (�j —�� � —r�SS,' <br />Vendor Name ! Business Name / UBI Number <br />���ii��''�� L : <br />State oE +,Vashington Contractor License Number: <br />� S��/o7 7/s~f�V� N� M/�IZYSviLL�s' 1,�//f S��S?i�� <br />� Vendor A4ailino Address Ciry Stat2 Zip <br />� � � 1 '�.�1�a7 <br />Phone <br />Einail <br />I, 1he \�entior, agree to rec�:ve tne Backe:�ater Preven!ion Device rebate check direcUy for the <br />insfallat�on a! the aoove reierenced oropery addre�s. 6y aareeing to receive the rebate chack <br />olrectly, I agrae to th= follo:ving: <br />The Back�vzter Preven0an Device rebate amount will be deductzd irem ?he fm21 invoice <br />�Iven !o the property o�vner ior the installa6on at the property address referenced above, i( <br />the total cost of the Instaliation is greater ?nan the reb3te. <br />2. I, the Vendor, am a lydashington State licensed contractor. <br />3 The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwa:er <br />Prevention Device rebata payments totalino more than S60D Ger calendar yo�r, ano �vill <br />report the same paymenis to �he Infemal Revenuo Service. <br />iI�c ;ept the payment of the Backe�ater Prevention Device rebale from the City oi Everett pending <br />approval of ihe completed Back�vater Prevention Device rzbate package by the City of Everett <br />Signature o( Contractor <br />�1- �;5 I5 <br />Date <br />