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Contractor Section: <br /> M�%�-����'=�---_ _ .__�o����_���—_ <br /> Vendor Name I Business N� e I U31 Number <br /> I � vt/� ��� :�_�.��-._�� � <br /> — — - --- -- <br /> State o(Washmgton Contractor Lic��nse Number: <br /> I �SI S �-( ( j`� ��. `�� -�tb:��,n„�� I,J�J Gl`��Z"!c.) <br /> Vendor Mailing �ddress City State Zip <br /> �r2 S 7 b 0 �_J�U- - �T n-r.,�' G. !�a-c..-� �(�...h,w c.0 t� i <br /> Phone Emad i <br /> - -- --- --- -----__- _ ---- _ - ------- -- _J <br /> I, the Vendor, agree lo receive the Backwater Prevention Dewce iebale check directly lor the <br /> installation al the above referenced propeAy address 8y agreemg to receive the rebate check <br /> direclly, I agree to lhe following <br /> 1 The Bar.kwaler Prevenlion Devir,e rebale amount will be deducted from the Ilnal invoice , <br /> given to lhe property owner lor ihe inslallation al Ihe property address relerenced above, if 'i <br /> the lolal cosl ol the mstallaGon is grealer than the rebate. <br /> 2 I, the Vendor, am a Washmgton Stale licensed contractor. <br /> 3 The Cily of Everetl will send a Federal Form 1099 MISC to me, lhe Vendor, for Backwater <br /> Prevenlion Device rebate payments totaling mo�e than $600 per calendar year, and will <br /> report ihe same paymnnts to thr. Inlemal Revenue Service <br /> I accept the payment of lhe Rar.kwater Pievention Dewce rebate from the City ol Everett pending <br /> approval ol lhc completed Backwater PrevenGon Device rebate package by the City of Everetl <br /> ��� '���ti,e_'_'_ _ � - � C.� "( S <br /> --�� <br /> Sgnalurc of Contraclor Date <br />