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Contractor Section: <br />' �-�> M�`?�lua'-f�- HFF (�lu�v�U�4'�91�� <br />_____ __Vendor.Name./-Business.Name./_UBINumber..._____..�___. <br />�1 ��1�� e l 1 F l� <br />State of Washington Coniractor License Number: <br />�(v 1� U i S"t'z� rc� � v1�c �i1/r: -F ��' y�' 1 t-,� t� ct d� ��� C5 <br />Vendor Mailing Address City State Zip <br />Phone Email <br />� <br />LLa�(��_.C�n�Rtl ^CI��� <br />I, the Vendor, agree to receive ihe Backwater Prevention Device rebate check dfrectly for lhe <br />installalion at the above referenced property address. By agreeing to receive the rebate check <br />diredly, I agree to the following: <br />1. The Backwaler Prevention Device rebale amount will be deducted ftom the final invoice <br />given to the property owner for the installation at the properfy address referenced above, if <br />the totai cosl ot the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington Stale licensed �nt�actor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backv�ater <br />PrevenUon Device rebate payments totaling more ihan $600 per celendar year, and wfll <br />report the same paymenis to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate `rom lhe City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Everett <br />��/ :� ,'� <br />"� '''�''�."'`-- ,�/v�! ��/� �y <br />Signature oi Contractor <br />�ate <br />