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Contractor Section: <br />Vendor Name / Business Name / UBI Number <br />John Pestell / Side -Sewer/ <br />Stale of Washington Contractor License Number. <br />SIDES**853K8 <br />Vendor Mailing Address City State Zip <br />P.O. Box 137 Mukilteo, Wa 98275 <br />Phone / Email <br />L4 /. <br />1, the Vendor, agree to receive the Backwater Prevention evice r ate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />directly, 1 agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for the installation at the property address referenced above, it <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />1 accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Everett <br />/eD -Z./-iS- <br />Date <br />