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Contractor Section: <br />A+ Sewer Technologies <br />Vendor Name / Business Name / UBI Number <br />603 089 164 _ <br />State of Washington Contractor License Number. <br />I <br />900 Meridian Ave E STE 19-193 Milton WA 983S4 <br />Vendor Mailing Address City State Zip ' <br />(888) 213-7656 infopsewertechs.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 />I. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for the installation at the prop" address referenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. ThL 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 Rovonuo Sorviee. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Bnckweter Prevention Device rebate package by the City of Everell <br />Walt n:..........m.s. <br />' 6�T111Ip 11lY 0VY CWC <br />Signature of Contractor <br />