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i <br /> Backwater Prevention Device <br /> � Rebate Program <br /> Vendor Section (please print): <br /> . . _, � <br /> __ , , _ , <br /> �l�_ .r�;�s�zsc.r7�`�J i, '�'� '.� '� ,�.��._ . �� (� ) ' /� <br /> �..cl_�— _ _i_._...........__--�..__... <br /> Vendor Name/ Business Nan�e/Uk31 Numher <br /> �;�:r�l�LS CF�J i�l(�'---�- -------------- ...-------�-- <br /> State of Washinglon Cantraclor Licens� Number. <br /> �_.2�5' ��5�����- ���+-r.�--�;�-�-��>«5 _w���- ----- ---���� '''�- I <br /> Vendor Mailing AddreSs City Slale zip <br /> �Z7-5��• 7'�t+:� _,c.�%L"'�i�i.n�Ve,�_•���,v-�1:4 i ie�d ,c'E�.•`��--- � <br /> Phone Email <br /> --- — --- — � <br /> f <br /> I, the Vendor, agree to receive lhe Backwater Prevention Device rebate check direr,lly � <br /> for Ihe installation referenced at ihe Property Address. By agreeing to receive Ihe rebafe � <br /> check directly, I agree to the followiny: <br /> � <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the Final ! <br /> invoice given to the Property Owner for Ihe installation al the Property Addre:s ( <br /> referenced 2bove, if the tofal cost of the installation is yrealer lhan ihe rehate. � <br /> 2. I, the Vendor, am a Washington State licensed contractor. � <br /> 3. The City of Everetl will send a Federal f=orm 1099 MISC to me, lhe Vendor, for <br /> the Backwater Prevenlion Uevice rebate paymenis totaling more than $600 per , <br /> calendar year, and will report the same payments to lhe Inlernal Revenuc I <br /> Service. � <br /> I <br /> I accept fhe direcl payment uf lhe Backwater Prevention Device rebate from thc: Cily � <br /> of Fverell prnding approvai of the completed {3ackwaler Prevention Device rebate <br /> package by lhe Cily of Everell i <br /> `'C-�� j �f� <br /> �-�'I.1-� C�. Z..:.4� ��.`- --- --- � <br /> ! <br /> iqnalw'e of Confracfor l.);dc <br /> 4 <br /> i <br /> � <br /> ( <br /> i <br /> � <br /> I <br /> r�aq�� 2 or z i <br /> r.����:�:d su:viui<< { <br /> � <br /> I <br />