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- � <br /> Contractor Section: <br /> �g-� p���������1-� �o.� 7x Z �� � <br /> Vendor Name/Business Name/U61 Nu ber <br /> -�=t�P����� <br /> State of Washinglon ConL•actor License Number. <br /> ��l/ l//�'r�'Gt-j2Z 4'�i Ct F�� ,PV,Z„C�.�i� t� � (��ZU <br /> Vendor Mailing Address City State Zip <br /> �Z-S- � �h�l- LYZ ? <br /> Phone Email <br /> a�a �� h, a G� � .�� <br /> 1, ihe Vendor, agree to receive Ihe Backwaler Prevention Device rebate check direcUy for the <br /> installation al ihe above referenced property address. By agreeing to receive the rebate check <br /> direcUy, I agree to the (ollowing: <br /> 1. The Backwaler Prevention Device rebate amount will be deducted from the final invoice <br /> given lo the property owner for the installation al the property address re(erenc�d above, it <br /> the tolal cost of the inslaliation is grealer lhan lhe rebale. <br /> 2. I, lhe Vendor, am a 1Nashington State licensed conlraclor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, lhe Vendor,for Backwater <br /> Prevention Device rebate payments totaling more lhan 5600 per calendar year, and will <br /> report lhe same payments to the Internal Revenue Service. , <br /> I accept ihe payment of the Backwaler Prevention Gevice rebale from the City of Everell pending <br /> approval of the compieted Backwater Prevention Device rebate packac�e by the City of Everett ; <br /> �� /1� .__;'�-i2-� v <br /> Signature of Contractor Date <br /> � <br /> � <br /> � <br /> . ; <br /> . 1 <br /> � <br />