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Contractor Section: <br /> �f�L�__�Lwr�13•�_ 1�a3 0/3 oS� � <br /> � Vendor Name / BusinessName!UBI Number � <br /> � I /� / <br /> I .L���S.C�'—!il'v�1�� ---- --- <br /> � State of VJashington Contractor License Numbec <br /> S�(.� �/S� /�UG� iv G �►�I�.i,Y.SV li/� k._�_ 70 <br /> Vendor Mailmg Address City Stale Zip <br /> _.?7� 7���1 <br /> Phone Email <br /> I - - — — — -- <br /> I, the Vendor, agree to receive the f3ack�vater Prevention Device rebate check direclly tor the <br /> installation at the above referenced property address. By agreeing b receive the rebate check <br /> directly, I agree to the follov�ing: <br /> 1 The Backwater Prevention Device rebate amount�vill be deducted from the final invoice <br /> given tn lhe property owner for the installation al the property address referenced above, if <br /> lhe total cosl of the inslallation is grealer than the rebate. <br /> 2 I, lhe Vendor, am a Washington State licensed coniractor. <br /> 3 The City of Everett�vill.send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br /> Pravention Oevice rebale payments lolaling more than 5600 per calendar year, and�vill <br /> report the same payments to the Internal Revenue Service. <br /> I accept ihe payment of Ihe F3ackwaler Prevention Device rebate (rom !he City of Everett pending I, <br /> � approval of the compleled Backwater Preventinn Uevice rebate par.kage by the City of Everelt �I <br /> I ~ --���"�`� II <br /> Signaturc of Conlractor Date <br />