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Contractor Section: <br /> oer‘ r•-, r ( Ud “(9 ?Li <br /> Vendor Name)Business Name,UBI Number • <br /> Poen PP 44 3;.1 0 <br /> State of Washington Contractor License Number: <br /> 1 7 5 1 5 1-.1 r ct Si- sr- S,-U.)110 -1 1's.G, Al q? Cl <br /> Vendor Mailing Address City State Zip <br /> (415 760 CS 3 6 v fe--e" & 110 CC)fli,,etni y, 4.o►�-, <br /> Phone Email l <br /> I,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 /> I 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 /> • <br /> 917-Z4-g— 6 - 10'slc <br /> Signature of Contractor Date <br /> y3 <br />