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Contrac:or Section: <br />Vendor Name / Busine�s Name / UBI Number <br />_�r�.Z `�-�--`��z1___�.I- <br />State of Washington Contractor License Number: <br />Vendor Mailing Address <br />Phona <br />Emaii <br />3. <br />City State Zip <br />I, the Vendor, agree to receive the Dack�vater Prevention Device rebate check direcUy for Ihe <br />installation at the above referenced property address. By ayreeing to roceive lhe rebate check <br />directly, I agree to lhe folloeving� <br />1. The Backwaler Prevention Device rebate amount will be deducted from the final invoico <br />given lo lhe property owner for the installation at the property address referenced obove, iF <br />the lolal cost of lhe installation is greater than the rebate. <br />2. I, lho Vendor, am a Washington State licensed contraclor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, Ihe Vendor, for Backwater <br />Prevention Device rebate payments totaling more ihan 5600 per calendar year, and will <br />report lhe same payments to lhe Internal Revenue Service. <br />I accept lhe paYmenl of the Backwater Prevention Device rebate trom tho Ciry oI Everett penAing <br />approval of the completed Backwater Prevention �evice rebate package by lhe City oi tveretl <br />�GC� -�— �<G� <br />Sipnature of Conliactor <br />� <br />1 <br />0 <br />Date <br />