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Contractor Section: <br />Vendor Name / 8usiness Name / U81 Number <br />of Washington Contractor License Number: <br />Mailing Address Cily State 7_ip <br />Emai1 <br />I, Ihe Vendor, agree to receive ihe Backwater Prevention Device rebale check directly tor lhe <br />installalion'at the above referenced property address. By agreeing to receive ihe rebale check <br />direclly, I agree to the following: <br />1, The Backwater Preventian Device rebate amount will be deducted from ihe final invoice <br />given to the property owner for the inslallalion at the property address referenced above, if <br />Ihe total cost of the inslallalion is grealer than the rebate. <br />2. I, the Vendor, am a Washington State licensed conlractor. <br />3. The City ot Everett wiil send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebale payments totaling more than 5600 per calendar year, and will <br />report the same paymenis lo the Inlernal Revenue Service. <br />I accept the payment of lhe Backwaler Prevention Device rebale from the Cily of Everett pending <br />approval of Ihe compleled Backwaler Prevenlion Device rebale package by Ihe City of Everelt <br />- . �—.. �L_. �y� �"f " � � <br />�al re o ntr� lor atD e <br />