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Contractor Section: <br />YW <br />Name / Business Name 1 UBI Number <br />�-/J%Hh�O// /� <br />State of Washington Contrector License Number: <br />�(��7`�ivrtf?��%� '�{�� f�� .9�a�3 <br />Vendor Mailing Address City State Zip <br />�..yg��—alZ�3 �lcr►,�'rz <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevenlion Device rebate check directly tor the <br />installation al the above re(erenced property address. By agreeing to receive the rebale check <br />directly, I agree to the (ollowing: <br />1. The Backwater Prevention Device rebale amount will be deducted from the final invoice <br />given to Ihe property owner for ihe installation at the properly address referenced above, if <br />the total cost o( the installation is greater ;nan the rebate. <br />2. I, the Vendor, am a Washington St�te licensed contractor. <br />3. The Ciry of Everett will send a Feceral Form 1059 MISC to me, ihe Vendor, for Backwater <br />Prevention Device rebate payments totaling more than 5600 per calendar year, and will <br />report the same payments to lhr_ Internal Revenue Service. <br />I accept the payment oi the Backwater Prevenlion Device rebale trom Ihe City of EvereL' pending <br />approval ol Ihe completed Backwater Prevention Device rebale package by the City of Everetl <br />��5'_�`` . '�t .c�l S� <br />Signature of Contracror ate <br />