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Contractor Section: <br /> /�Yu�,,LU �s�.M i��n/v (�.'> — GI 3 — c`i S S� <br /> Vendor Name/Business Name! UBI Number <br /> /�r�1� �c.' L: - — <br /> Stato o(Washington Contractor License Number: <br /> -S�J 7Js~Av1 NL- M/�12Y.SiJI//.j`_W�/ —�� c� <br /> Vendor Mailinp Address City State 7_ip <br /> �"�:..SJ �rlS� ''l.507 _ _� <br /> Phone ' Email <br /> I, the Vendor, agree to rec=ive the Backwater Prevenlion Device rebale chock direcUy for lhe <br /> installation at the a6ove referenced property address.By agreeing to receive the robate check <br /> direc�ly, I agree to the folio�ving: <br /> 1. The Backwater Prevention Dovite reba�o amount tvill be dedualed from the final invoice <br /> glven to the property owner for the installation at th�property address referencad above,If <br /> the toial cost of lhe inslallation (s greater than the rebate. <br /> 2. I, the Vendor, am a Washington Slate licensed contraclor. <br /> 3. The City of Everett�vill send a Federal Form 1099 MISC lo me, the Vendor,for Backwater <br /> Prevr.ntion Devico rebato paymenls tolaling more than 5600 per calendar year, and will <br /> report Ihe sam�payments to ihe Intemal Revenue Servir.e. <br /> I ar.cept the payment of the�ackwaler Prevention Device rebato from thn Cily oF Fver�it pendinr� I <br /> approval of the compleled Backwaler Prevenlion Device rebate packar�e by the City M Evereil <br /> � (�- 12 — cS" <br /> SignaWre oi Contractor Date <br />