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Contractor Section: <br />Vendor Name I Busine�s Name / UBI Number <br />��_��-�� `�� � t.� � � L <br />State of�Washington Contraclor License Number: <br />Vendor i�4ailing Address <br />Phone <br />Email <br />Ciry State Zip <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for ihe <br />installalion at Ihe a6ove referenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducled from the final invoice <br />given to the property owncr (or the installalion 2t Ihe property address teferenced above, iF <br />fhe total cost of the installalion is grealer than Ihe rebate. <br />2. I, the Vendor, am a Washington State Iicensed contraclor. <br />3. The City oi Everett �vill send a Federal fbrm 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate paymenis lotaling more than 5600 per calendar year, and will <br />reporl the same paymenls lo the Internal Revenue Service. <br />I accept the payment of the Backwater Provenlion Device rebate irom the Ciry of Everett pending <br />approval of the completed Backwaler Prevention Dedice rebale package by ihe Cily of Everett <br />Signature of Conlractor <br />a a�1� _— <br />Date <br />