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Contractor Section: <br /> ���( ,�-,� <br /> "�(�.�Y� �?t�r�{'h_`�irl ��Y/` LLC� ��Z�-1—`� <br /> Vendor Name 1 Business Name! U81 Number <br /> � zP �- �S �ol � K�_ <br /> State of Washington Contraclor License Number: <br /> �ar�-y,: ��r.1�ri�. Ei .er�F I��A G� -,' <br /> Vendor Mailing Address City State Zip <br /> ,'�i";{�- .�j����R�. � 1 c�r'�!i'k�:(`i�tii�'I:Sv��#;uytx(,�t' ' �J•C���77 <br /> Phone Email <br /> L <br /> I,the Vendor,agree to receive the Backwater Prevention Device rebate cheGc direclly for the <br /> inslallation at the above re(erenced property address. By agreeing to receive the rebale check <br /> directiy, I agree fi the following: <br /> 1. The Backwater Frevention Device rebate amoun!�vill be deducted fmm the final invoice <br /> given lu Ihe property owner for lhe inslatlation at lhe property address refQrenced above, if <br /> the total cost of the installation'is grea[or than the reba[e. <br /> '! 2. I, the Vendor,am a Washington State licensed wntractor. <br /> 9. The Cily of Everett wili send a Faderal Form 1099 MISC to me, Ihe Vendor,Tor Backwater <br /> Prevention Device rebete paymenis totaling more than 5600 per calendar year, and will <br /> report the same payments to the Intemal Revenue Senrice. <br /> I accept me payment of the E3ackwater Prevention Device rebate from the City o�Everett pendmg <br /> approval of ihe completed Rackwater Prevention Device rebate package by the(;ity of Everett <br /> ����� �.��� <br /> Signature of Cont2ctor Date <br />