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Contractor Section: <br />0 <br />Vendor Name I Business Name I Uef Number <br />_�-�p/u ly�o//P/,1 <br />State of Washington Contractor License Vumber. <br />�(p �/ r// ffic vaf�ec. 19T�-z�� �}- 9�'t-U$ <br />Vendor Mailing Address City Slate Zip <br />42 5—�89-��Z 3 /9i4 �;�, �r�� _ � C rnL.0 <br />Phone Email <br />I, the Vendor, agree to receive the Beckwaler Prevention Device rebate check direcUy for the <br />installation at lhe above referenced property address. By agreeing to iecei�e the rebate check <br />direclly, I agree to the tollowing: <br />1. The Back�,vater Preventlon Device rebate amount will be deducted ftom the final invoice <br />given to ihe property owner for the instailation at the property address referenced above, if <br />the total wst oi the installalion is greater than lhe rebale. <br />2. I, the Vendor, am a Washinglon State licensed contractor. <br />3. The Cily of Everelt will send a Federal Form 1099 MISC to me, the Vendor, for Backwaler <br />PrevenUon Device reGate payments totaling more than $600 per calendar year, end will <br />report the same payments to the I�temal Revenue Service. <br />I accept thc payment of Ihe Backwater Prevention Device rebate from the City o( Everett pending <br />approval ot the completed Backwater Prevenlion Device rebate package by lhe City of Everett <br />� �/ '.r <br />"��i.� _.�_.Ll\� <br />Signature of Contractor <br />Date <br />