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Contractor Section: <br />� rl_15�^i.Ct�►�-- •�c: ��--- 'tc,'-r-LLG (y�c�3 3�L�r�3 <br />IVendor Name f Busine s Name I UBI Number <br />_��'1��5 �-�-��K�-� - <br />Slate of Washington Contractor License Number. <br />�' �I�'O� �--CIl � t �—! . ,h ,__—f�iv �' 1 i' I i ���_--L����- <br />VCndor Mailing Address City State ZiP <br />� '�r� [�� , r ��C72_ <br />Phone Email <br />I, the Vendor, agree to receive the Backv�ater Preventioi� G��vice rebate check directly for lhe <br />installation at the above ieterenced prope�ty address. By agreeing lo receive the re6ate check <br />direc!ly, I agree to the follovrin,� <br />i. The Backvrater Prevenlion DeviCe rebate amount will he deducted from the final invoice <br />given to the property owner for lhe installation al the property address referenced above, if <br />the total cost o( thc installalion is greatcr than lhe rebate. <br />2. I, the Vendor, am a Washington Slate licensed contractor. <br />3. Thc City at Eveieti �•+ill send a Federai Porm 1099 MISC to me, the Vendor, far 8ackwater <br />Prevenlion Device rebale payments totaling more than 5600 per calendar year, and will <br />report the same payments to Ihe Inlertial Revenue Service. <br />I ar.cepl the payment of the Nackwaler Prevention Device rebale from Ihe City of [verett pending <br />approvai of the completed Back�valer PreveNion Device rebate package by ihe Ciry of Everett <br />� �z�' g as s <br />�..�_ <br />Signature of Contractor Date <br />