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Contractor Section: <br />l�1 ���,, 1��� M ti.:� � �� G�r �i �t��,�. <br />Vendor Name I Business Name U81 Number <br />Mven l�(� �` �f8 3.To <br />State of Washington Contractor License Number: <br />� 7S i 5 �� r� S{ S/= S���Ho,�-��'s� �^'D r%I�aciU <br />Vendor Mailing Address City State �ip <br />w�S 7bU ts <br />Phone <br />1,r<� <br />Email <br />.LONI <br />I, the Vendor, agree lo receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced propeRy addross. By agreeina to receive the rebate che:k <br />directly, f agree to the following: <br />7. The Backwater Prevenlion Uevice rebate amount will be deduct=d irom the final invoice <br />given to the propeAy owner for the installation at the property address referenced above, if <br />the total cost of the Installation is preater than the rebate. <br />2. I, lhe Vendor, am a lNashington State iicensed �ontractor. <br />3. The City of Everettwlll send a Federal Fomi 1099 MISC to me, the Vendor, for Backwater <br />Prevention Devire rebate paymenls totaling more than 5600 per calendar year, and will <br />report the same payments to Ihe Internal Revenue Service. <br />I accept the payment of the Dac{nvater Prevention Device rebate from lhe City of Everett pending <br />approval of the completed Backwater PreveMlon Device rebate packape by Ihe City of Everetl <br />SignaWre of Contractor <br />3- a �- i s� <br />Date <br />