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Contractor Section: <br /> . . �'^^ �ljFi[ /�� �ir�P �l".UP���Gl�,� �����a <br /> Vendor Name/Business Name/UBI Number <br /> t <br /> �z({� S� S��o I KI <br /> State of Washington Contractor License Number: <br /> _ ��� -,.� L�rl� � �� Ei.��f �.t)fl q�3 <br /> Vendor Mailing Address City State Zip <br /> �X�- ,�';In . �n�--�i'�;����rmr��r� �� y���_ -e�7� <br /> Phone Emaii <br /> I,the Vendor,agree to receive the Bacl.kwater Pravention Device rebate clieck directly for the <br /> insiallation at the above referenced property address.By agreeing to receive the rebate check <br /> direcUy, I agree to the follow�ng: <br /> 1. The Backwater Prevention DeYice rebale amounl will be deducted from the final invaice <br /> given to the propeRy owner for�the installation at the property address referenced above, if <br /> �� ihe tofal cost of tha installaflon is greater than the rebate. <br /> . 2. I,lhe Vendor,am a Washington State iicensed conhactor. <br /> 3. The City of Everett will send a Federal Fortn 1099 MISC lo me,the Vendor,for Backwater <br /> -� P�eveDHon Device rebate paymenLs totaling more than$60�per calendar year, and will <br /> repoA the same payments tc the internal Revenua Service. <br /> I accept the payment of Ihe 8ackwater Prevenlion Device rebate from the Ciry of Everett pending <br /> . approval of lha oompleted Backwaler Prevention Device rebate package by ihe City of Everett <br /> Signature of Coniractor Gale <br />