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Contractor Section: <br /> �/�G/�G }�/u� 3�.�� Ga3 c/3 �SFS _ <br /> Vendor Name!Business Name/UBI Number <br /> �/�G// PG ��3 Gi <br /> State of Washinglon Conlractor License Number: <br /> S�/o7 7/S'�,A�e .✓F t^ci�YSUri�G_y`�'¢� �z '�G <br /> Vendor biailing Address City State Zip <br /> ���zS� 3(67 /Sc7 <br /> Phone Email <br /> I, the Vendor, agree to receive lhe Backwater Prevention Device rebate check direclry for the <br /> installation al the ahore referenced property address. By agreeing to receive the rebate check <br /> diredly, I agree to the following: <br /> t. The Backwater Prevention Device rebate amount �vill be deducted from the fmai invoice <br /> given to the property owner for the installation at the property address referenced above, i( <br /> lhe total cost of Ule installation is grealer than the rebate. <br /> 2. I, the Veodor, am a Washington State licensed conlraclor. <br /> 3. The Cily of Evcrelt�vill send a Federal Form 1099 MISC lo me, the Vendor, for Backwater <br /> Prevention Device rebate paymenls totaling more than 5600 per ca�endar year, and will <br /> report the same paymenls to the Internal Revenue Service. <br /> I accepl the payment of Ihe Racktivaler Prevention Device rebate from lhe City o( Everelt pending I <br /> approval of ihe completed Dackwater PrevenUon Device rebate package by the Cily of Everett <br /> Z,lz�� <br /> Signature oi Contractor Date <br />