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Contraetor Sec!%nn: <br />Vendor Name / Business Neme ! U81 Number <br />�M�f�,�-��I KL_ <br />SFate of Washington Contractor License Number. ' <br />f �r yo +-4 r l � ��,P . E�.r�f (d�_9 �' <br />� Vendor Mailing Address City State Zip <br />. <br />:I� ,._. � •u". i �t. �. � <br />.• <br />I, the Vendor, agrce to receive the Baekwater Prevention Devi� rebate check directly for the <br />installatlon at the above referenced prbperty addrass. By agreeing to receive the rebate check <br />directly. I agree to lha folbwing: <br />i <br />1. The Backwater Prevention De�ice rebate enwunt will be deducted from the flnal Inwice <br />given lo the p�operty oxmerfa! the inslalietion at lhe property address refarenced above, If <br />ihe tata! cost of the i�stslleHon'is greater then the rebeta. � <br />2. 1, the Vendor, am a Waehington Stete liceiued conhacfa. <br />3. The City of Evereft will send a Federel Fortn 1099 MISC to me, fhe Vendor, for Backwater <br />Prevention Device rebate payments tofaling more than 5600 per celendar year, and wiil <br />report the same payments to the Intemal Revenue Service. <br />I accept the payment o( the Backwater Prevemion Device rebate from tha City of Everett pending <br />approval of the completed Backwaler Preventian Devke rebate package by Ihe City of Everett <br />��'. ��� <br />Signature of Contractor Date <br />