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Contractor Section: <br />2— 7/ 2— <br />Vendor Name I Business Name! JBI <br />State of Washington Contractor License Number: <br />� • <br />c�o �'I 1//,�"Q%V�,v�-'�.1�.` - �'Y' <br />Vendor Mailing Address • . �� • � . City ,.: ^�. State Zip <br />i.,, . ..�_:1 , . .�..- <br />2 � ��. 9:-ts7 23 <br />Phone <br />Email <br />L <br />I, the Vendor, agree to receiJe ihe Backwate� Prevention•DeSice. rebate check di�edtly fo� the <br />installation at the above re(erenced property address. By ag�eeing to�receive the rebate check <br />directly, 1 agree lo lhe following: ' <br />1. The Backwater Prevention Device rebate amount �vill 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 Washington State licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevenlion Device rebate payments totaling more than 5600 per calendar year, and �vill <br />report the same payments to the Inlemal Revenue Service. <br />I accepl lhe payment of lhe Backwater Prevention Device rebate from the City of Everett pending <br />approval of ih� completed Backwater Prevention Device rebate package by the City of Everetl <br />Sig Contraclor <br />, .. . <br />� � <br />S �l 1-/ 5 � <br />Date �.. <br />