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Contractor Section: <br /> ��`�vr�l ��� oa-��a -�r 3 , <br /> Vendor Name! Business Name/ U81 Numbe " <br /> �e%l��i�eD —_- — <br /> Stale of Washinglon Contractor License Number: <br /> �l1 'lE�� �°� �i G�- ��08 <br /> Vendor Mailing Address City State Zip i <br /> L�� —�'8� -b�z3 �,�I�:�hc� g [.�c�-�i�6n �.Z_ u-�-� <br /> ,�-- <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check directly tor'he <br /> instailation at the above reFerenced prope�ty address. By agreeing to receive the rebale check <br /> direclly, 1 agree to the following: <br /> 1. The Backwater Prevention Device rebate amount�vill be deducted frem the final invoice <br /> given to the propeAy owner for the instatlation al the propeAy address reFerenced above, if <br /> lhe total cost of the installation is greater than the rebate. <br /> 2. I, lhe Vendor, am a Washington State licensed contraclor. <br /> 3. The City of Everett will send a Federai Form 1099 MISC to me, the Vendor, for Backwater <br /> Prevention Device rebate paymenls totaling more than$600 per calendar year, and will <br /> reporl the same paymenls lo the Internal Revenue Service. <br /> I accept the payment ot the Backwater Prevenlion Device rebale from the Cily o(Everett pending <br /> approval of the compteled Backwater Prevention Device rebate package by lhe Ciry of Everelt <br /> ���-�=/ S <br /> Sigi Date <br />