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Contract�r Section: <br /> — -- --���- <br /> \ <br /> ;"�-��a"r�`� ���,-- `Ati� �� -�i�=�—Y`��� <br /> Vendor Name J Business Name/UDI Number <br /> � �� r'� — <br /> S ate of Washinglon Conlractor License Number: <br /> ��=���=�-��,����LV�1�� �� 1 ✓ Z�'�� <br /> Vendor Nlailing Address City State Zip <br /> ^ I <br /> �i'-zs ��c� ��sE�LCr.�►s�Zs rs �-' <br /> Phone Email C ,`,,4�1 � '�� <br /> r��� <br /> I, lhe Vendor, agree to receive the Backwater Prevenlion Oevice rebate check d�rectly for the <br /> installalion al lhe above referenced property address. By agree�ng to receive the rebate check <br /> direclly, I agree lo the followino: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from Ihe fnal invoice <br /> grven to the property owner for Ihe installahon at the propeAy address referenced above, if <br /> the total cost of the instaltaUon Is grealer than the rebate <br /> 2. I, Ihe Vendor, am a Washington Stale licensed contractor. <br /> 3 The City o(Everett will send a Federal Porm 1099 MISC to mc, the Vendor, lor Backwater <br /> Prevention Device rebate payments totating more Ihan $600 per calendar ycar, and�vill <br /> report the same paymenls to the Intemal Revenue Service. <br /> I accepl the paymenl of Ihe 5ackwaler Prevention Device rebale from the City of Everelt pending <br /> approval of Ihe compleled E3ackwater Prevenlion Device rebale package by the C�ty ol Everelt <br /> ,,,�� � � _ �s <br /> ,5' nature OAlra� Dal� <br /> ( <br />