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Contractor Section: <br />Vendor Name / Business Name / UBI Number <br />�bs�� � �-��� ----- - <br />State c' Washington Contractor License Number: <br />����_��3�� s�w. <br />Vendor Mailing Address-� <br />r��u�� <br />Pbone --- - ...._ _��.. ..�. ._FinaiL .. <br />,:: <br />I, the Vendqr,'agree to r.eceive the Backwater Prevention Device rebate check'directly for the <br />installa:ion at the above referenced properry address. 8y agreeing to receive the rebate Gieck <br />directly, I agree to the (ollowing: <br />t. The Backv�ate� Prevention Device rebate amount v�iil be deducted from the final invoice <br />;given lo'the properly owner for lhe installatiun at the property address referenced above, if' :. <br />�the tola(cost of the installation is greater than the rebate: - <br />2, I, the Vondor, am a Washington State licensed contractor., <br />3. The City nf Everett will send a Federal Form 1099 MISC'to me, the �;endor, (or Backwater <br />Preventlon �evice rebate payments totaling more than 5600 per calendar year, and �t�ill <br />report tlie same payments to lhe Inlemal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate (rom the CHy of EvereH pending <br />I approval of the comple!ed Backwa!er Prevention Device rehate package by the City of Everett <br />`il �(_,�'[eR1.-Q/: t%, `�'?�(.Sf <br />Signature of Contractor Date <br />!�, -- _ - — -- — ..--, T. --- — <br />_ ..._.�.. _ ,....._ _ . ,. <br />"1...°�.l'" '" d , .M�ir�:.kiYit:�:.. ��,�,. .:�..rcw,e � ��,��r�,.fw4�t+.^r'r,e�F�d..� � �.....�'''�,ru�'?[? ��. +waw,k�F <br />,.r�.r ,.. �... ... . __L„_ <br />