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� Backwater Prevention Qevice Rebate Program <br />Rebate Submittal Checklist <br />Submit your rebate packet within 90 days from the date the installation is inspected and <br />approved by tlie city. Use this checklist to make sure that it includes all of the necessary <br />materials. The items indicafed (CONTRACTOR) will be provided to you by your contractor. <br />Your rebate packet must include the following: <br />❑� Completed and signed Rebate Application Form (green) <br />❑ Compteted and signed IRS Form W9 "Request for Taxpayer ldenlification Number and <br />Certification" (white) <br />� Vendor Payment Option Form (purple) signed by you and the contrector IF you want the <br />rebate check sent to ihe contractor. Otherwise, the rebate veill be sent to you. <br />�✓ Compteted 8ackwater Prevention Device Final Installation Checktist [CONTRACTORJ <br />� Itemized invoice for the work, showing contraclor name, address, license number and the � <br />detaited costs of installation and materials [CONTRACTOR]. - <br />� <br />� Map of your property wilh localion oi the installed device (CONTRACTOR] <br />When the packet is complete, mail or deliver It to: City of Everett, Atln. BWPD Rebate <br />Program, 3200 Cedar Street, Everett, WA 98201. <br />