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Contractor Section: <br /> _�,����. �,�� i3�;, _ G�3 0l3 os8 <br /> Vendor Name I Business Name I U81 Number <br /> .f;/�v//J�L 9�G% <br /> Stale of Washington Contractor License Number: <br /> _��/GJ /s�/QV2 ��i M.�I/�N�v' i�P- �27G . <br /> Vendor Mailing Address City Stale Zip <br /> ' (yzs) 3f�7�- /5�7 � <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the foilowing: <br /> 1. The Backwater Prevention Device rebate amount wiil be deducted from the final invoice <br /> given to ihe property owner for ihe installation at the property address referenced above, d <br /> lhe lotal cost of lhe installalion Vs greater Ihan the rebate. <br /> 2. I, lhe Vendor, am a Washinglon Stale licensed coNractor. <br /> 3. The City of Everett wili send a Federal Form 1099 �v11SC lo me, the Vendor, for E3ackwaler <br /> Prevention Oevice rebate payments tolaling more than 5600 per calendar year, and ���ill <br /> report the same payments to Ihe Internal Revenue Service. <br /> I accept the paymenl of lhe Backwater Prevention Device rebate from the City o( Everelt pending <br /> approval of the completed Backwater Prevention Device rebate package by the Ciry oi Everett <br /> ,� l J���iS <br /> � <br /> Signalure o(Contraclor Dale <br />