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Contractor Section: <br />i��>�(_S � . �r,t``".�1,��'=(C��`� l �-L f�iL-' <br />Vendor Name I E3usiness Name I UBI �dumber <br />��j�C� l_Gl(�iZ,�-� <br />Stafe of VJashington Contraclor I_icense Number. <br />Vendor I�lailing Address � City State 7_ip <br />Z�) ��=�,3 ����L� �,'(��LL �i)7`�S )l�l��i��tV� �/''t'},!_l__�(pt"1 <br />Phone Email �� <br />I, ihe Ventlor, aaree lo receive lhe Back���ater Prevenlion Device reoate check d��rectly (or R�e <br />installation al the above referenced p�operty address By ayreemg to mcenre tne rebate cneca <br />directly. I agree to Ihe folloviinn� <br />1 The Backwater PrevenUon �evice rebale amouN vnll be tieducted Irom ihe final invoice <br />given to the property ov+ner for the. installatlon at Ihe property adtlress reterenced above, d <br />the total cosl of Bie installaUon is yreater than Ihe rebate <br />2 I, thc Vendor, am a l4'ashinyton State licensed contractor. <br />The Cdy o( Everett �•+ill send a Federal Form 1099 iu11SC ro me, Ihe Vendor, lor l3achc�ate.� <br />I�revenlion Device rebate payments totahng more than $600 per calendar year, ar:i �v�il <br />icpuit the same payrnents to lhe Intzrnal Revenue Serv�ce. <br />i accepl the payment ot the B�ckwaler Prevention Device rebate from Ihe Cdy of f_veietl pcnd nq <br />�PProval ol the r.ompleled 5ackv,aler f ievenhon Device rebate pachage by Ihe City of Fveretl <br />---��- --- <br />nlracror <br />� ? (u i � <br />��z <br />