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Backwater Prevent�on Device <br /> � -� Rebate Program <br /> Vendor Section (pleas�a print): <br /> SEATTLE DRAIN SERVlCE 602830336 <br /> Vendor Name / Business �'ame/UBI Number <br /> SEATTDP936 <br /> State of Washingtun Contractor License Number: <br /> IC�rMailin Add�re,s`�s � � City L Stale� l�j <br /> � �. 1� <br /> ` Phone206-632-8069 (� _ �����P(( II'I�PL)1L� ����� <br /> �;11�.. <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directiy for <br /> the installation referenced at the Property Address. By agreeing to receive the rebate <br /> check directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted (rom lhe final <br /> invoice given to the Property Ovmer for the installation at the Property Address <br /> reierenced above, if the tolal cost of tlie installation is greater than the rebate. <br /> 2. 1, the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, lhe Vendor, for <br /> Iihe Backwater Prevention Device rebate payments totaiing more than $600 per <br />, caiendar year, and will report the same payments to the Internal Revenue <br /> Service. <br /> I accept the direct payment oF lhe Backwater Prevention Device rebate from the Cily of <br /> Everett pending approval of the compleled Backwater Prevention Device rebate <br /> package by the City of Everelt <br /> I — � ----- .. . _.. ___ ... _._..._ _ - -- - <br /> /: . _ _.. <br /> �,. . -- - _ . ��-- �.--�,�. <br /> Signafure lConUacfor Date <br /> Page 2 ot 2 <br /> Revised 9/3/2014 <br />