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;• . ' <br />Contractor Sectlon: <br />— .�-__. -- <br />Vendor Name / Business Neme / U81 Number <br />State ot <br />Vendor <br />Conliacloi License Number. <br />City <br />� <br />State <br />Zip <br />� <br />I, Ihe Vendor, egree to reee�ve the Backwater Prevenlion DaNce rebale check directly for the <br />instellation at the above referenced property address. By agreeing to re�eive the rebate check <br />dlreCtly, I agree to the lollowing: <br />1. The Backwater Prevention Device rebate amaunt Nnli be deducted fram ihe final Invoice <br />given to tha property ovmer for the Installatlon at the property addross referenced above, if " <br />the tolal cost o( Ihe installation Is greater than the re6ate. <br />2. I, the Vendor, am a Washington State Ilcensed contractar. <br />3. The City of Evereri will send a Federal Fortn 1099 MISC to me; Ihe Vendor, for Backwaler <br />PrevenGon Device rebafe paymenls totaling more than 5600 per calendar year, and will <br />report the some paymenta to fhe IMemal Revenu� Service. <br />I accept the payment of ihe 6ackwaler Prevention Devlce rebate Irom Ihe City of Everett pe��ding <br />approvel of the completed Backvraler Prevenllon Oevfce rebate package by the Cl�y ot Everett <br />' ' •, <br />� ' . ' •� . . <br />1..�..._: _—_..... __: _ .�__.. <br />,^� "'� � � <br />Date <br />