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Contractor Section: <br />Vendor Name / Business Nam� / UBI Number ��� <br />/J <br />Washington Contractor License Number: <br />G�-7�Z- 7! 3 <br />d���/ Ul S�a�va �a . d9� �r..3►9-- ��Z�_ <br />Vendor Mailing Address . City State Zip <br />• � • • .. •. <br />�4-i �_ /-1 S�—t�f�23 Gl2 r01 uno �'n�r LL L�-�C�a, <br />Phone <br />Email <br />I, the Vendor, agree to receive the Batkwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to Peceive the rEbate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted irom the final invoice <br />given to the property owner for the installation at the propeAy address reterenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City oi Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totaiing more than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accept ihe payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approvai of the completed Backwater Prevention Device rebate package by the City of Everett <br />of Contractor <br />!a- ��� `� <br />Date <br />