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Contractor Section: I <br /> , <br /> /��`;�L/,� I�LuMI� �NG (� '> -GI � - �iSSl � <br /> Vendor Name I Business tJame I UBI Number I <br /> � I <br /> /1r��L� F'i 9c�i [:T <br /> State of Washington Contractor License Number: <br /> S�o7 7/S ��V. N�;_ �9/�LZ. SY ✓�l/-I, lNA Q4�7c� <br /> Vendor Mailing Address Ciry State Zip <br /> �l w 'SS_7���'07 <br /> Phone ' Email <br /> I, the Vendor, agree to rec�ive the E3ackwater Prevenqon Device rebate check directly for ihe <br /> insiallation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to ihe following: <br /> 1. Tho Back�+�ater Prevention Devioe rebate amount•,vill be deduated from the final invoice <br /> 9iven to the property oivner for the instaliation at the property address referenced above, if <br /> lhe total cost of the installation is greater than the rebale. <br /> 2. I, the Vendor, am a VVashington St;,te ilcensed contractor. <br /> 3. The Cily of Evereft will send a Federal Form 1099 MISC to me, the Vendor, for Backedafer <br /> Prevenfion Device rehate pr,yments totaling more than 5600 per caiendar year, and�vlll <br /> reporl lhe same paym2nts to ihe Intemai Revenue Servi�e. <br /> i accept the payment o(the Backwater Prevenlion Device rehate from the City of Everett pending <br /> approval of tho compleled Backwater Prevention Device rebate package by the City of Everett <br /> ^1� <br /> Signature of Contracta ___ Date <br />