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ConYractor Section: <br />Vendor Name I 8usine�s Name I UBI Number <br />�L-J� LIZ-�- -� tr� � --+-�`--- — <br />Slate of Washington Contractor License Number: <br />�=� L�_r_�u��II�-- <br />�E N� r��tl-_ ���_�' ��G�:�. <br />Vendor M3iling Address City State ZiP <br />u?,�� �°� � , , C' [�I%2 -- <br />Phone Email <br />I. the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />inslallation al �he above referenced property address. By agreeing to receive the rebaie check <br />directly, I agree to the following <br />1. The Back�vater Prevention �e��ce rebate amount will be deducted from the final invoice <br />given to the property o�vner for the installalion at the property address referenced above, iF <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washinglon State licensed contractor. <br />3. The City of Everett �vill send a Federal Form 1099 MISC lo me, Ihc Vendor, tor Backwater <br />Prevention Devir,o rebate payments lotaling more than �6D0 per calondar year, and ���ill <br />repoR ihe same paymenfs to the Internal Revenue Service. <br />I accept the payment of the Backwaler Prevenlion Device rebate from the City of Everett pending <br />approval o( the compleled Back�vater Prevention Device reba�e package by the City of Everett <br />� � - �, <br />- ��'_ � �.�� <br />Signalure of Conlracror <br />----�-�--�� <br />Date <br />