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Backwater Preventioi� D�evice <br />Rebate Program <br />Vendor Section (p;pase print): <br />/ Business Name / UE�I <br />,,., � �ti„ .. , <br />State o( Washington Contraclor <br />�?2>. �'z��l� C,1. Sr.J, <br />Vendor Nlailing Address <br />Phone <br />N <br />EI'131� <br />State Zip <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check direr,tly <br />for the installation referenced at the Property Address. By agreeing to receive the rebate <br />check directly, I agree to the folioia�ing: <br />1 <br />?. <br />3. <br />The �ackNreter Prevention Device rebate amounl will be deducted from the final <br />invoia-: given lo th[: Property O��mer ior ihe installation at the Property �ddress <br />referenced above, if Ihe total cost of the installation is greater than the rebate. <br />I, the Vendor, am a Washingfon Statr. licensed contractor. <br />The City of Evereit will send a Federal Form 1099 MISC to me, the Vendor, for <br />the Qackv✓ater Prevention Device rebate payments totaliny more Ihan $G00 per <br />calendar ycar, and will report the same payrnents to lhe Intemal Revenue <br />Scrvice. <br />I accept the direct payment of the liackv�aler Prevention Device rebate irom lhe City <br />of Everett pending approval of the completed Ciackwater Pruvention Devir.e rebate <br />par,kage by the City of f_verett <br />' '\ <br />/ ` ��/� <br />_ �:, �S'11,�,,� -- – — <br />Sir nature ol ContraGor <br />- ��_��� �-�'v�J <br />oara� <br />('ag�, 2 nf 2 <br />Revc�,ad f)1JI2UId <br />