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Contractor Section: <br /> 1���-���r��-�F� L�3-�s�.s- ll`� <br /> Vendor Name/Business fJa /UBI Number <br /> ��ralss �'f-�. \ s� <br /> Slate of UVashington onfractor License Number: <br /> �2,3 236�f-� � �i,,�. �i�2c��5 �q �s�o�6 <br /> Vendor Mailing Address City State Zip <br /> �6' �"���' ��q� /-f�5�1i�eS'bFi'�a,a�9ce..�1,R�o.�G,l�.c:nM <br /> Phone Email <br /> I, ihe Vendor, agree to receive ihe Backwater Prevenlion Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive th� rebale check <br /> directly, I agree to the(ollowing: <br /> 1. The Backwater Prevention Device rebate amount vdill be deducled irom the final invoice <br /> c�iven to the property o�vner for the installation at the property address referenced above, if <br /> the total cost of the installation is greater lhan the rebate. <br /> 2. I, the Vendor,am a Washington State lice�sed contractor. <br /> 3. The Ciry of Everetl�vill send a Federal Form 1099 MISC to me, the Vendor, for t3ack�vater <br /> Prevenlion Device rebale payments totaling more than$600 per calendar year, and v+ill <br /> reporl the same payments lo the Internal Revenue Service. <br /> I accept lhe payment o(the[iack�vater Prevention Device Pebate from the City of Everetl pending <br /> approval of the compleled Backwaler Prevention Device rebate package by the City of Everell <br /> � �� �- s— o � <br /> Si na ur of Contractor Date <br />