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Contractor Section: <br />�P�iu,'s �L��hf��ah I►.�r �tibZ 1Z���`�iti <br />Vendor Name / Business Name / UBI umber <br />c��PgPz� �"1 �'�5 <br />State of Washington Contractor License Number. <br />�a 4�0� S� I �r��' c�- Gi�7�co <br />Vendor'�ailing Address City State Zip <br />�Z.,r7Z�7�'i-���'I� S�rJ��c�DCC��nb�llS-������{��nc_['Au <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />direclly, I agree to lhe following: <br />1. The Backwater Prevention Device rebate emount will be deducted from the final invoice <br />given to the property owner for the installation at the property address referenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed wntrector. <br />3. The City of Everett wil( send a Federal Form t099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />report the same paymenls to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwaler Prevention Device rebate package by the Cily of Everett <br />Sig ure of�Contractor <br />.� <br />��—��� 1�' <br />Date <br />