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Contractor Section: <br />��C -� (�OZ� 35�780 <br />Vendor Name / Business Name /�UBI Number <br />`�C,'Wer � L G1 I lr rn� <br />State of Washington Contractor Licenso Number. <br />� X'��� 5_ l-�1 f���,6ti�i,�G�, w'� �iFJD4 (�� <br />Vendor tvtailing Address <br />Phone <br />City State Zip <br />U,ii�CSC.Wf'r�Y IP,Vt({ ����C_'Om <br />Email <br />I, lho Vendor, agree to receive the Baclnvaler Prevention Device rebate check dlrectly for the <br />Inslallation at the above referencod property address. By agreeing to receivo the rebate chec� <br />directly, I agreo to 1he foliowing: <br />i. The Backwater ProvenNon Oevlce rebate omount will be doducted from Ihe final Invoice <br />glven to the property owner for Ihe inslallation at lhe properly address relerenca_tl above, if <br />the total cost of Ihe installation is greater than Ihe rebate. <br />2. 1, the Vendor, am a Washinglon Slate licensad conlroctor. <br />3 The City of f_verett will send a Fed�ral Form 1099 MISC to me, the Vendor, for Bacfnvater <br />Provenlion Device rebate payments tolali�g morc ihan 5600 per calendar year, and will <br />repori the same payments lo ,he Intemal Rovenuc Ser��lce. <br />I aa:ept Ihe paymanl oi ihe Dackwaler Prevention Devicc reb�te from the Clty of Everott ponding <br />approval of Ihe comploted E3ackwoter Preveniion Device rebale packape by tho City ot [veietl <br />/� <br />'����%�� ��'��� - - <br />Signature of Conlractor Date <br />