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Contractcr Section: <br /> Sewer-- �r ; ' U� L�' c � Ct U 2 � 3S 78C <br /> Vend�r Name/ 8usiness Name ! UBI umber <br /> se.we�� -� l- �11 �.� vN S <br /> State of Washington Contractor License Number. <br /> �c� 1�� �!-I�_--��jnn�� ��"O�+l� i <br /> Vendor Mailing Address Gty State Zip � <br /> �9 �`�1� ��-}�18 �I�,+��eC��;e,wer-�ri���dlV, (��m <br /> Phone — Email � <br /> I, lhe Vande-, agree lo receive ihe Back�vater Prevention Device rebate check directly for the <br /> installation at the above referenced prcperty address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> 1. The Back�•�ate r Prevention Device rebate amount will be deducter' from the final invoice <br /> given to the property owner for the installation at the property audress referenced abuve, if <br /> the total cost of lhe installation is grealer than the rebate. <br /> 2. I, lhe Vendor, am a Washington Stale licensed conlractor. <br /> 3 The Cib�of Everch will send a Federal Form 1099 MISC lo me, the Vendor, for Backwater <br /> Prevention Device rebate payments Iotahng more than 5600 per calenda� year, and �:ill <br /> report the same payments to the Inlernal Revenue Service. <br /> ___ ---- ------- 1 <br /> I accept the paymenl of the Backwater Prevenlion Device rebate from the City o(Evereit pending <br /> approval of the completed Backwater Prevention Device rebate package by Ihe City of Everett <br /> �T��,��:�� �t,�<>-e <br /> , <br /> Signature of Contractor Date <br />