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Contractor Section: <br /> cil�G_f�IN /113inci LX/.3 G�3 �' s� <br /> Vendor Name/ Business Name/UBI Number <br /> /��LL �; ;E�3 GT <br /> Stale of Washington �oniractor License Number: <br /> -$'�/c7 7/S�/.jv�. � . .vtc��ysutiii Lv� ��r.�7c� <br /> Vendor Maiiing Address Cily. State Zip <br /> L�.�S /Sn7 <br /> Phone Email <br /> I, lhe Vendor, agree lo receive the Backwaler Prevention Device rebate check directly for the <br /> installation at the above re(erenced property address. By agreeing to receive the rebate check <br /> direcUy, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amounl will be deducted from the final invoice <br /> given to lhe property owner for lhe installaGon at lhe property address referenced above, if <br /> the total cost ot lhe installation is grcaler than ihe rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The City oi EvereU will send a Federal Form 1099 MISC lo me, the Vendor, for Backwater <br /> Prevention Device rebate payments rotaling more than $600 per calendar year,and will <br /> report Ihe same payments to ihe Internal Revenue Scrvice. <br /> I accept the paymenl o(lhe 8ackwaler Prevenlion Device rebate from thu City of Everett pending <br /> approval of the completed Backwaler Prevention Device rebate package by ihe Cily of Everetl <br /> �/S/Za�� <br /> �Signature of Conlractor ' Date <br /> ---- -- — ----- ----- — -- <br />