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Contractor Section: <br />Vendor Name / 8usiness Name ! UBI Number <br />���-�.���� � � <br />State of Washington Contractor I_icense Number: <br />Vendor Mailing Address City State Zip <br />I, ihe Vendor, agree In receive the Backwater Prevention Device rebate check direcUy for the <br />installation at the above referenced property address. By agreeing lo receive the rebale check <br />direclly, I agree to the follawing: <br />1. The Backwater Prevention Device rebale amount will be deducted from the 6nal invoice <br />given lo the property owner for lhe installation at the property address re(erenced above, if <br />Ihe total cost of the installation is greater lhan lhe rebate. <br />2. I, the Vendor, am a Washinglon Slate licensed contraclor, <br />3. The City o( Everelt v�ill send a Federal Form 1099 MISC to me, Ihe Vendor, tor Backwaler <br />Prevention Device rebate paymenls tolaling more Ihan $60D per calendar year, and �vill <br />report lhe same payments lo the Internal Revenue Sr.rvice. <br />I accept the payment o( the Backwater Prevention Device rebatr, from thc City o( Everetl oending <br />approval of the completed Backwaler Prevention Device robale package by lhe City of Everel; <br />re o \ �{r c�or <br />\ <br />7 <br />� <br />Dale <br />