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Contractor Section: <br />t iClC - N jr ci,✓- `� LL '� f C Lc = _`v_a'� 32si 3 <br />Vendor Name Busine s Name UBI Number <br />Slate of Washington Contractor License Number. <br />Vendor Mailing Address <br />Phone <br />City State Zip <br />._('j_(-e. <br />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 follovnng' <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 .he installation is greator than the rebate.. <br />2. I, the Vendor, am a Washington State 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 />renort the same payments to the Internal Revenue Service - <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Fverett <br />Signature of Contractor Date <br />a <br />