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Contractor Section: <br />.:�5g <br />Nendor Name / Business Name / Uf31 Number <br />i <br />��M� � 1���G i �,�- - <br />State of Washmgron Contractor License Number: ' <br />s; �Qy� ��arl� r�,��e . � Ei.�r�F �fl ���'�— <br />Vendor Mailing Address City State Zip <br />(.7lIR--'^—'If� • ���_--���(1�ir�YW.rrCCtn��P� �Citi4'�Cc(J77 <br />Phone Email <br />I, the Vendor, agree to receive the Ba�kwater Prevention Devi�e rebale check direclly for the <br />installalion at the above referenced prbperty address. By agreeing to receive lhe rebate check <br />direcUy, I agree to the foilowing: <br />1. The Backwater Preve�tion DeYice rebate amount will be deducted from the final invoice <br />given lo the property owner foq the installation at the property address reterenced above, if <br />ihe lot�l cosl of Ihe installation�is greater than the rebate. <br />2. I, lhe Vendor, am a Washington State Ifcensed contraclor. <br />3. The City of Everett will send a Federel Fartn 1099 MISC to me, the Vendor, (or Backwater <br />Prevention Device rebate payments totaiing more Ihan $600 per calendar year, and will <br />report the same payments to the Intemal Revenue Service. <br />I accept Ihe payment of lhe 8ackwater Prevention Device rebate from the Ciry of Everett pending <br />approval of the comple�ed Back�roaler Prevention Device rebate package by the Ciy of Evetell <br />•_� Z <br />Signature of Coniractor Date <br />