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Contractor Section: <br />� �r_►�.�.� <br />Vendor Name I <br />� <br />Name/U81Numher <br />j Q._L`i�i�`�_� �� ''J--��--- <br />I State of ��'ashington Contractor License Number <br />�, <br />�?.l���'i_(s_ 1--�_ _r�i_L`1—�1_',_ —.��✓_�1�1f _ �-��' �'��G� <br />Vendor Ntailing Address City State Zip <br />Phone Email <br />i, the Vendo�, agree to receive the Back�vater Prevention Device rebate check direcUy tor the <br />installation at the above referenced prop�rty addross. By aareeing to receive ;he rebale check <br />directly, I agree to the following: <br />1. The Backwater PrevenGon Device rebate amount wili he deducted from the final invoice <br />g'ven to the property owner for lhe installation at t'ne properbj address referenced a6ove, if <br />th:� total cost of the installation is n,reater than the reba�e. <br />I, ihe Vendor, am a Washington Slate licensed contractor. <br />The City of Fverett �vill send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention 7evice rebate payments tofaling more than 5600 per calendar year, and tvill <br />report tfie same payments to the Inlernal Revenue Service. <br />I accept lhe paymenl of lhe Back�valar Prevention Device rebate irom the City of Everett pending <br />epproval of the completed Backwaler Prevenlion Device rebate package by the City of Fverelt <br />���.�_. �� ....�' __- <br />Sionalure of Contractor <br />1G.�Ia_�LJ <br />Date <br />