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Contractor Section: <br /> 4 r2 LL2 PLL M Zi AJ1 t . —c-/ 3 - 5' <br /> Vendor Name/Business Name/UBI Number <br /> /rr'PLL a 9o$ L <br /> State of Washington Contractor License Number: <br /> 5 <br /> *,7 M mA1 Y.S vZ-114 tAM f'f 7a <br /> Vendor Mailing Address City State Zip <br /> Phone ` Email <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given to the property owner for the installation at the property address referenced above, If <br /> the total cost of the installation Is greater than the rebate. <br /> 2. I,the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me,the Vendor,for Backwater <br /> Prevention Device rebate payments totaling more than $600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> 1 accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> Signature of Contractor _ Dat; <br /> r <br /> • <br /> /{ <br /> f <br /> r <br />