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Contractor Section: <br />i /ii�l.(.D i�Lyt.- /f'I,j�1t/c: (x�j -cil � -ciSSl <br />I Vendor Name ! Business Name / UBI Number <br />i <br />� �1�G ���%i1� <br />� State oF Washington Contractor License Number. <br />I S fci7 7/j �i4vf N�= M.AIZYS ✓�/� �, W� � a <br />Vendor Mailing Address City State Zip <br />(�/ � S� 5�s7 �'1.�a7 _. <br />Phone Email <br />I, the Vendor, agree to receive lhe Backwater Prevenlion Device rebate check directiy for tha <br />installation at the above re,`erenced properiy address. By agrezing to receive ihe rebate check <br />directly, 1 agree to the following: <br />7. 7he Backw2ter Prevention Device rebate amount �viil be deducted irom the final invoice <br />given to the property o�vner for the insiallation at the property addrass referenced above, if <br />the total cosl of the inslallation is greater than the rebate. <br />2. I, the Vendor, am a Weshington State licensed contracbr. <br />3. The City oi Everett will send a Federel Form 1099 MISC to me, lho Vendor, for Backe�ater <br />Preveniion Device rehnte payme�ts totaling more than 5600 per calendar year, and will <br />report the samo paymanls to Ihc Internal Revenue Service. <br />I acc�pt the paymenf of the Oack»�ater Praventlon Device rebate from the Cily of Everett pr.ndin� � <br />approval of the completed Backwaler Prevention Device rebate package by the Ciry of Everett <br />Sinnalure o( Contractor ��_ <br />