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Contractor Section: <br />Sewer- Tr i e ^ LLC <br />U o �_ 3� 79D <br />Vendor Name 1 Business Name f UBI Number <br />SeW -N- -� l- ill lc �v, S <br />State of Washington Contractor License Number: <br />Pc-) RLx D41 5 LunY)Nw �U `Hq(o <br />iVendor Mailing AddressCity <br />State <br />p I <br />�LD gCID 14 /O vWt w�PWeYtf <br />�IZip <br />I>U17G� rr) <br />Phone Email <br />� <br />I <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate 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 following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for the installation at the property address referenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. i. the Vendor, am a Washington State licensed contractor. <br />1 The City of Everett will send a Federal Form 1099 MISC to me, the Vender, for Backwater <br />Prevention Devicc rebate payments totaling more than S600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending i <br />approval of the completed Backwater Prevention Device rebate package by the City of Evere t <br />�j�� / I <br />Signature of Contractor Data <br />