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Contractor Section: <br />Vendor <br />/UBINumber._. . _ -,/, : ___ _ -_, ::, .. <br />' r��.Nu L� D i/� J -- <br />State of Washington ConL-actor License Number. <br />�� �/ �rSTa v����cti tN�= f v��v.�� i L�r7 9�'Z��o <br />Vendor Mailing Address Cily State Zip <br />d� Z� <br />Phone <br />Email <br />�1 <br />!: • <br />I, the Vendor, agree to recefve the Backwater Prevention De��ice rebate check directiy fur 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 BaGcNater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner For the installation at the propeAy address referenced above, 'rf <br />the totai cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed conlractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the b'endor, for 8ackwater <br />Prevenlion Device rebate payments totaling more then $600 per calendar year, and will <br />repoA the same payments to lhe Internal Revenue Service. <br />I accept Ihe payment of lhe Backwater Prevenlion Device rebate from the City of Everett pending <br />approval of Ihe compleled Backwater Prevention Device rebate package by the City of Everett <br />c f - /__-- <br />l.�, +^ /,�, 5 <br />.� �� G <br />�nature of Contractor <br />/l�o� ;s2�,i�► <br />Date <br />