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Contractor Section: ' ' <br /> �A PI �,��, b,���,��c �l�Q� • �-�� ��z— �B3 <br /> Vendor Name/Business N me/ UBI Number ' <br /> ��tPlul�- ��iR� � <br /> State of Washington Contractor License Number. <br /> ��D// U/B�-l�cZ.%F1�c� � • �I�B/t�7- �uD9 /d�l-�'b � <br /> Vendor Mailing Address � City ' State Zip <br /> �t:zs=�f;s— o�z-j . - : . _ .>,�/��,h«,�G���i �,:�.� � <br /> Ptione ' Email . . <br /> I, lhe Vendor, agree to receive the Backwater Prevention Device rebate check directly for ihe <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> direclly,l agree to the following: <br /> 1. The Backwater Prevenfio� Device rebate amount will be deducted from the final invace <br /> glven to the property o�mer for the installalion at the property adMess referenced above, if <br /> the total cost of the installation is greater than the rebate. <br /> 2. I, the Vendor, am a Washington Sfate licensed contractor. <br /> 3. The City of Everetl wili send a Federal Form 1099 MISC to me, lhe Vendor, for Backwater <br /> Prevention�evice rebate payments�otaling more than$6D0 per calendar year, and will <br /> report the same payments to the Inlernal Revenue Service. <br /> I accept the payment of lhe Backwater Prevention Device rebate from the Ciry of Everett pending <br /> approval of ihe wmp{eted Back�vater Prevention Device rebale packago by the City of EvQrett <br /> ��,/i�_ � .R . . .. `��Z��` _ - <br /> SignalureoFContractor ' Date �� <br />