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Contractor Section: <br />%� <br />Vendor Name / Busi <br />State of Washington <br />Vendor Mailing Address <br />-3�7-1sv? <br />Phone <br />! UBI Number <br />License Number: <br />Email <br />� <br />City / State Zip <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directty for the <br />inslallation at the above referenced property address. By agreeing to receive the rebate check <br />directly, I agree to the rollowing: <br />1. The Backwater Prevention Device rebate amount vaill be ded�eted from the final invoice <br />given to the property owner for the instaliation at the property address reFerenced above, if <br />the total cost of the installation is greater than the rebate. <br />2. i, the Vendor, am a Washington Stale licensed contraclor. <br />3. The City of Everelt will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebale payments totaling more than S600 per calendar year, and �vill <br />report Ihe same payments to the Intemal Revenue Service. <br />I accept the payment of the Backwatcr Prevention Device rebate from the City of Everelt pending <br />approval o( the conipleled Backwater Prevention Device rebate package by the City of Everett <br />/J��/S <br />Date <br />