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Contractor•Section: ' <br /> � U �-I //T � �� �T t��� v <br /> a� F1�.u2 �iSa o. oP-y��,tN �e� 6�3—�A.S I � �- <br /> 'Jendor Name!Business Name/UBI Number <br /> �}�S���S ��.��� <br /> State of Washington Contraclor License Number: <br /> `}f�s a���s�sw f����s w� a8�?6 <br /> Vendor Mailing Address City State Zip <br /> �6 ' �6�� 7�qz l-��56�uf�5'f�ha���eR�J�u;�C6�� <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 tollowing: <br /> 1. The Backwater Prevention Device rebale 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 totai cost of the installation is greater than the rebate. <br /> 2. I, the Vendor, am a Washinglon 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 /> ieport lhe same payments lo the Internal Revenue Service. <br /> I accept Ihe payment of the Backwaler Prevention Device rebate from the City of Everett pending <br /> approval of ihe completed Backwater Prevention Device rebate package by the City of Everett <br /> C�ue , � � I-a �l- aoy� . <br /> ignat e of Contractor ' Dale <br />