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Contractor Section: <br /> ��C.�/U j''/!.c/'�l;in�i ��i�� GL�G C�__ <br /> Vendor�Jame/ Business me/ UBI Number <br /> RtoGL �L. 9cr �G T <br /> State of Washington Contractor License Number: <br /> S'%o7 7/f`,4�� ,✓;; r��,,sn L ;�e �,,. � ��-?� <br /> j Vendor Mailing Address City State Zip <br /> ��7 - /_So7 <br /> Phone Emaii <br /> I <br /> I, the Vendor, agree lo receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreemg to receive the rebate check <br /> directly, I agree to the following: <br /> t. 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 aoove, 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 ot Everelt will send a Federal FoTn 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate payments rotaling more than $600 per calendar year, and wiil <br /> repoR the same payments to the Internal Revenue Serv�ce.. <br /> , -- —� <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending � <br /> approval of the completed Backwa�er Prevention Qevice rebate package by the Ciry of Everett <br /> � <br /> _ �-�:�-���-� . <br /> Signature of Contraclor Date <br /> --- ----J <br />