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Backwater Prevention Device <br /> � r Rebate Program <br /> Vendor Section (please print): <br /> SEATTLE DRAIN SERVICE 602830936 _ <br /> Vendor Name/ Business Name/ UBI Number <br /> SEATTDP936 <br /> State of Washingtron' Con�ctoc�icen��6�er��. ��lv� <br /> �t�—���'�L J� <br /> Vendor Mailing Address City State Zip <br /> Phone 206-632-8069 Emai <br /> ���i �C . <br /> I, the Vendor, agree to receive the Backevater Prevention Device rebate check direcliy for <br /> the installation referenced at the Property Address. By agreeing to receive the rebate <br /> check directly, I agree to the follotiving: <br /> 1. The Backwater Prevention Device rebale amount will be deducted irom ttie final <br /> invoice given to Ihe Property Owner for the installation at the Property Address <br /> referenced above, if the total cost of the installation is greater than the rebate. <br /> 2. 1, the Vendor, am a Washinglon State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for <br /> the Backwater Prevention Device rebate paymenls totaling more than $600 per <br /> calendar year, and �vill report the same payments to lhe Internal Revenue <br /> Service. <br /> I accept the direct payment of the Backwater Prevenlion Device rebate from the City of <br /> Everell pending approval ot th� completed Backwater Prevention Device rebate <br /> par,!,age by the City of Everett <br /> ` ���1C��- � � ��3�% <br /> Signature otiConfractor Date <br /> Page 2 of 2 <br /> Revised 9l3l2014 <br />