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Contractor Section: <br />--�c7— <br />�� � � S v_a.i�, d9�- �wv� b t <br />Vendor Name I Business Name I UBI Number. <br />��}- pl� (•,�'��1 Pr� <br />State of INashington Contractor License Number. <br />B(a G� v! S�-1'Q+'�t 14� ��� �-- 9� � <br />Vendor Mailing Address Gty State Zip <br />Z5=4B�'_orz3 �1°���,-�I�;n�1.Lc�-4�@� <br />Phone Email <br />I, Ihe Vendor, agree to receive the Backwater Prevention Device rebate check direcUy for the <br />instatlation al lhe a6ove reterenced property address. By agreeing to receive Ihe rebate check <br />direclly, I agree lo lhe following: <br />1. The Ba�k�vater Prevention Device rebate amount wili be deducted from the finai invoice <br />given to the property owner for the installation at ihe property address referenced above, i( <br />lhe total cosl of the inslallation is grealer than the rebate. <br />2. I, the Vendor, am a VVashington State licensed contractor. <br />�c <br />3. The City oi Everett will send a Federal Form 1099 MISC lo me, lhe Vendor, for Backwater <br />Prevention Device rebate payments totaling more Ihan 5600 per calendar year, and will .^ '� ' <br />report the same paymenls to ihe Internal Revenue Service. ,� <br />I accept the payment of lhe �ackwater Prevenlion Device rebale from Uie City of Everett pending <br />approvai of Ihe compleled Backwaler Prevenlion Device rebale package by Ihe Cily of EveretP• <br />Signa ofConfraclor <br />1 <br />�ti. <br />(p -3 �- r 5� . <br />Dale <br />