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Contractor Section: <br /> f�A PI �,� b,�n � ,������ . �� ��z- �a3 <br /> Vendor Name/Business N me/ UBI Number <br /> A-� Pl�/fa�iR2 _ - <br /> State of Washington Contractor License Number: <br /> // /,gTa-l�Qi4'ta• /�t�` ' gl2'K�7— �t/b1 ��l/1Z� <br /> Vendor Mailing Address City State Zip <br /> �(,ZS=,�B9__o1Z3 „�-1�1�ti.,l�vt�rLGC�{7�C�3a,.u�L.. u,.,1 <br /> Phone Email '� <br /> I, the Vendor, agree lo receive the Backwater Prevention Device rebate check direcliy for the <br /> inslallation at the above referenced property address. By agreefng to receive the rebate check <br /> directiy, I agree to the following: <br /> 1. The Backwaler Prevanlion Device rebate amount will be deducted from the final invoice <br /> given to lhe property owner for the installation at the property address referenced above, if <br /> the rotal cosl of the installation is grealer than lhe rebate. <br /> 2. I, the Vendor, am a Washington Stale licensed contractor. <br /> 3. The Cily of Everett will send a Federal Form 7099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate payments Iotaling more lhan 5600 per caiendar year, and will <br /> report the same paymenls lo the Inlernal Revenue Service. <br /> I accept lhe payment of the Back�vater Prevention Device rebate from tho City of Everetl pending <br /> 2pproval oi lhe compieted Backwaler Prevention Device rebate package by the City of Everett <br /> 1-� —_�-��� n �— - —- <br /> Signature of Contractor Date <br />