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Contractor Sect, on: <br />FF <br />Icy.^ Ot.,r,%irtr, <br />t! D<-;Ll - <br />Vendor Name(/ Bnu;lnessCNa e / UBI <br />Number <br />State of Washington Contractor License Number: <br />17515 �tl`}7f. Sr <br />t,G, wA C,Y1 0 <br />Vendor Mailing Address <br />City State Zip <br />LI S '7C U ��(✓t✓ <br />'I rcn� w' r, u[..n (��r h;r�y c�„� <br />Phone <br />Email <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 abovo, if <br />the total cost of the Installation is greater than the rebate. <br />2. I, the Vendor, am a Washington Stale licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevention Device rabalo package by the City of Everett <br />Signature of Contractor Date <br />