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Cc�ntractor 5ectlon: <br />/— <br />Vendor Name / Business Name / U9I Number <br />State of 1Nashington Contrador License Number: <br />Vendor Mailing Address City State ZiP <br />��- d <br />Phone Email <br />.,. _.._ _;._..:...� ....., _..,....:..r;'.�.t��a���L`avicerebatecheckdiredlyforthe <br />inslallation at the above referenced property address. By ag2eing to receive the rebate check <br />diredly, 1 agree to the following: <br />1. The Backwater Prevention Device reDete artrount w?II �N G�.Uu..��.�.: i�r�n U10IIIIOI IIIYLIW <br />given to the propeRy owner for the instailation at the property addtess referenced abo�re, 'rf <br />the total cost of the installation is greaber than tha rebata. <br />2. I, the Vendor, am a Washinglon 5tz�le licensed contractor. <br />3. The City of Everett will send a Fecleral Form 1099 MISC to me, the Vendor, for Backwater <br />Preventior Device rebale paymenb totaling more than $600 per calendar yoar, and will <br />report the same payments to lhe Iniemal Revenue Sarvice. <br />I accept the paymertt of the Backwater Prevention Device rebate from the City of Everelt pending <br />approval of the completed Backvrater Prevention Device rebate package by the City of Eve�ett <br />�v ���� �S� <br />Signa uC—re of Contxactor Date <br />�� <br />