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Gontractor Section: <br /> �GIIG j��ccnBlnc ��s S --- <br /> Vendor Name I Business Name/ UBI Number <br /> ��_1���_.3_LT - - -- <br /> State of Washington Contractor License Number: <br /> S� ' -- y u' u' i✓u/YS✓�i/e �v ,9 S�7✓ <br /> Vendor Mailing Address � Cily Slate Zip <br /> _3�,�i�� - <br /> Phone Email <br /> I, the Veno�r, agree to receive the �ack�vater Prevention Device rebate check directly (or the <br /> installation at the above referenc=d propeAy address. By agreeing to receive the rebate check <br /> direcUy, I agree to the lollo�ving: <br /> 1. The Backwater Prevention Device rebate amounl v+ill�be deducted (rom lhe final invoice <br /> given.to the property o�vner for the installation at the pmperty address referenced above, i( <br /> the total cosl o(the inslallation is grealer than lhe rebate. <br /> 2. I, the Vendor, am a Washington Slate licensed contractor. <br /> 3. The City of Everett v�ill cend a Federal rorm 1099 MISC lo me, Ihe Vendor, for Backwater <br /> Prevention Device rebate paymen;s lotaling morc than 5600 per calendar year, and witl <br /> report the same paymen�s to the Intemal Revenue Service. <br /> I accepl lhe payment o(lhe Backwater Prevention Device rebate from the City of Everell pending <br /> approval of the compleled Backwater Prevention Device rebate package by the Ciry of Everetl <br /> � 3�����,� <br /> Signature of Contractor Date <br />