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Con4ractor Sectlon: <br />/ /i <br />Vt dor Name / Business Name! <br />.��1.� l,->%�t <br />Sta f V� <br />�i- <br />\ Vepdor M <br />, <br />r'r`� <br />Number <br />, ,_,t., � ,� <br />�/�' C�� L'' � 1..( �v� •L • �/ :_� <br />Contractor License Number. <br />E, / � � ,�� <br />� L� � �� � ���,�, <br />City Siate, Zip <br />,� <br />/ 3 � c�-% %�if�L' �� �;; �����.;1 `S <br />Phone Era�it <br />� <br />.1 " f �.. , i ' . • 1 <br />��5 " 7�---� � � '�,�._t,�:.�� � �'i=�"s_ <br />� <br />I, the Vendor, agree !o receive the Backwater Preventlon Dewce rebate check directly for the <br />installalion at the above referenced property address By agr=_eing to recefve Ihe rebate check <br />directly. 1 agree to the foflovnng <br />1 The 8ackwater Prevention Device rebate amount �v�ll be deducted from the final invoice <br />given to the property avner for the instaliation at tne property address reterenced above, d <br />the total cost ol [he irntnllallon is grealer fhan Ihe rebate <br />2, I, the Vendor. am a Washingt�n Stale Ilcensed contractor. <br />3 The City ot Everett wdl send a Federal Form 7099 tvilSC lo me, tha :+endor, for Bac��vater <br />Prevention Dev�ce re6ate payments totaling rnore than 56�'b per r.alendar year, and v:ill <br />report the same payments to the internal Revenue Servlr.e <br />I accept 6ie payment of lhe Bac.4water Prevenlion �ewce rebate (roni the Ciry ol [verett pending <br />approval of the completed Bacl;v+ater Prevention Device rebate packago by the City of F.veretl <br />��_ ��� <br />ialuro of Nractor <br />� <br />� 4 r �/�_ <br />Date <br />