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Contractor Section: <br /> � --- -- ; <br /> A,����� ar�.M�:,��—�,� ��3 �ss� <br /> Vendor Name I Business Name I UCiI Number <br /> A����c.3c,� --- - - — <br /> Stale ot Washington Contractor License Number: <br /> �� 7�� Av� N�. r�:;.n!Sv�lie .�^•�' 9rs�?a <br /> � <br /> Vendor Mailing Address City Slate Zip <br /> �/���? ;.�� <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater PreveNion Device rebate check direcUy tor the <br /> installalion at the above referenced property address. By agreeing to receive ihe rebate check <br /> directly, I agree lo the following: . <br /> t The Backwater Prevention Guvice rebale amount�vill be deducted from the final invoice <br /> given to the property o�vner tor Ihe installalion at lhe property address re(erenced above, i( <br /> �he tolal cost of ihe installalion is grealer Ihan lhe rebale. <br /> 2. I, the Vendor, am a Washington Slate licensed contractor. <br /> 3. The City cf Evere�t will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Oevice rebate payments totaling more than 5600 per calendar year, and vrill <br /> report the same paymenls ro the Intemai Revenue Servicc. <br /> I accepl the payment of Ihe Backwater Prevention Device rebate trom lhe City of Fverett pending <br /> approval of the compleled�E3ack�valer Prevention Device rebale package by lhe Cily of Everelt <br /> ' _.—_, ��..S�ZU/,S� <br /> Signalure of Contraclor Date <br />