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Contractor Section: <br /> ����.��-�s�����- ���-/ r�3� ��s- _��� -_ _ <br /> Vendor Namc I Dusiness Name l,UBI N�mber <br /> �'of� i/�,� f�Z�VSDI� )�� � <br /> —------`—t_L--`—._— , - - - -- --- <br /> St�te of VJashington Conlraclor License Number. <br /> '�. � ��-k s-�s�v. �����(s w�a q���� ; <br /> Vendor Mailing Address City State Zip <br /> ��- ��� �y�_ ���o����-f-o���, �,rd���M0.��. a�� <br /> Phone Email <br /> L_ — - — <br /> � <br /> I, the Vendor, agree to receive the Backwater PrevenUon Device rebate check directly for the <br /> ,nstailation at the above referenced property address By agreeing to receive the rebate check <br /> d�rectly, I agree to the followmg: <br /> 1. The Backwater Prevenlion Device rebale amount will be deducted (rom lhe(inal invoice <br /> given to the property ormer(or Ihe inslallal�on at Ihe property address referenced above, d � <br /> lhe total cost of the installation is grealer Uian Ihe rebale. <br /> 2 I, lhe Vendor, am a Washinglon Slale Gcensed conlraclor. <br /> 3 The City ot Everett wdl send a Federal Form 1099 tv11SC to me, the Vendor, for Backwater I <br /> Prevention Device rebate paymen�s tolaling more than SG00 per calendar year, and will I <br /> ie{;ort ihe same paymenis to lhe Intemal Revenue Service. ' <br /> II acceut the p�yment of the Backwaler Prevenlion Device rebate from lhe Cdy of Everetl pending <br /> approval of Ihe comp�eted Bar.kwater Prevenlion Device rebate package by ihe City of Everett � <br /> 4 <br /> �,� ; � � � - ,I �ai a��s <br /> nat�ure ol Contraclor Dale <br />