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Contractor Section: <br /> — — -� <br /> � fFr'GlI�I��� �a� c i� �S�S <br /> Vendor Name; Business Name / OBI Number <br /> /�1��1-_'L�s��!---- - — � <br /> i —` , <br /> State of Washinyton Contractor License Numher i <br /> � _—_5:�_7 ���1y �G^'"--� -- . �^-••r.sr���c _ :.,._?_.—.�.��—_ . <br /> '✓endor Wiading Address City State Zip <br /> �••i2s� 7rn7 •'�7 --- - � <br /> Phone Email <br /> li — -- — <br /> I, the Ve��dor, agree to receive lhe Backe�ater Prevenlion Device rebale check directly tor the <br /> installation at the above referenced property address. By agreeing lo receive lhe rebale check <br /> direclly, I ayree to lhe following: <br /> t The Backwater Prevention Device rebate amount will be deductzd from the final invoice <br /> given lo lhe property owner for the installalion at the properly address referenced above, i( <br /> the btal cos� of ihe inslallation is grealer�han lhe rebate <br /> 2 I, the Vendor, am a lNashington Slate licensed coNractor. <br /> I 3 The Cily of Everett will send a Federal Form 1099 MISC to me, lhe Vendor, for Back�vater <br /> Prevenllon Device rebate payments totaling more than 5600 per calendar year, and v�ill <br /> .I <br /> report lhe same payrnenls to Ihe Inlernal Revenue Seivice. <br /> � -- - -- <br /> II accept the paymenl of the Back��:ater Prevention Device rebate from the Gty uf Fverett pendiny ', <br /> � approval o(lhe comple(ed 0�ckvaaler PrevenUon Device rebate package by lhe Ciry of Fverel� <br /> I � <br /> �J `'--- / L�z z//� I <br /> r_ — <br /> Signature of Cuntractor Dale <br /> i <br /> L - - -- - - - ' <br />