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Contractor Section: <br />CSS PLUMBING & SERVICE LLC 1602 950117 <br />Vendor Name / Business Name / LIBI Number <br />CJSPLPS915OD <br />State of Washington Contractor License Number: <br />5528 218TH'AVE NE GRANITE FALLS WA <br />98252 <br />Vendor Mailing Address City State <br />lip <br />360.691-5159 CJSPLUMBING O MSN.COM <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 />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount 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 Stale licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 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 payments to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pendi <br />dapproval of the completed Backwater Prevention Device rebate package by the City of Everett <br />Signature of C n r Date <br />ng <br />