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Contractor Section: <br /> �-- — <br /> ' ��zp �R�uw�3 � Nca U.�- Cco3 -42-�— DI (.e _ <br /> Vendor Name/ Business Name/ UBI Number <br /> N-� 8�C_�� 3N s- <br /> State ot V�iashinglon Contractor License Number: <br /> �b �x �87 .S�w o� �s��- �,�,�- . 9�2g l <br /> Vendor Mailing Address City State Zip <br /> ��a-4z� cr,- 0 9 2.9 -���,,�-C"o //iF�3 � �''�a�o o. �o,,,• <br /> Phone Email <br /> I, the Vendor, agree to receive the Bar.kwaler PreventiomDevice rebate check directly for the <br /> installalion at Ihe above re(erenced property address. By agreeing to�receive the rebate check <br /> duectly, I agree to lhe follo�ving: <br /> 1. The Backwater Preven�ion Device rebate amount wil� be deducted from the final invoice <br /> given to lhe property owner for the installation at the property address refer�nced above, if <br /> the total cost of the mstallation is greater than the rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everetl will send a Federal Form 1099 MISC to me,.the Vendor, for'Backti�ater <br /> Prevention Device rebate payments totaling more than $600 per calendar year, and will <br /> report the same paymenls to the inlernal Revenue Service. <br /> I accept fhe paymen�o(the Backwater Pr2vention Device rebate (rorn lhe Cily oLEverell pendiny <br /> approval ol ihe completed Backwater Prevention Device rebate package by the City of Fverett <br /> S 3 l�_ <br /> Signature of Contractor Dale <br /> I _ . — -- <br />