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Contractor Section: <br /> Sewer_�r� i�1(�I�/+ L�' � � cz02 � 357g0 <br /> Vendor Name/ Business Name/ UBI umber <br /> S�W�Y"' � I�— �I� �P- W� S <br /> State of VJashington Contractor License Number: <br /> �LZL�x �-1-I5 � nnti o����8'O�I(o � <br /> Vendor Mailing Address City Stale Zip j <br /> �plfl 8�10 �f4� 8 ���i�.�S�,wer-�ri�ncllv,�pm <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate checY,directly for the <br /> instailation at the above referenced property zddress. By agreeing to receive tlie rebate check <br /> direclly, I agree to the follo�ving: <br /> 1. The Backwater Prevention Device rebata amoun;wiil be deducted from the final invoice <br /> given to the property o�vner for the installation at the property address referenced above, if <br /> the total cost of ihe instaliation is greater Ihan the rebate. <br /> 2. I, lhe Ve�dor, am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Back�vater <br /> Prevenlion Device rebate payments totaling more than �,600 per calendar year, and will <br /> repoR the same paymenis to the internal Revenue Service. <br /> I accept the payrnent of lhe Backwater Prevention Device rebate from Ihe City of Everetl pending � <br /> approval of the completed Backwater Prevention Device rr-.bate package by the City of Everett � <br /> I <br /> i <br /> i <br /> � <br /> �l/�• ��c,C� �2 iS � ' <br /> Signature o(Contractor Date <br />