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Contractor Section: <br /> ��GI/G /7�Lb/!(�r�7s/ (iJG� G�7 �/Sn <br /> Vendor Name/ Business Name/UBI Number I <br /> �4P��//�L r}ri3GT <br /> State of Washington Contractor License Number: <br /> 5�/07 7/'S�Avc N!� i"ia.ysu,.i� wA' /rd� 70 <br /> Vendor Mailing Address City State Zip <br /> �S� 3�7 /s�7 <br /> Phone Email I <br /> -- — � <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> direclly, I agree to ihe tollov+ing: <br /> 1. The Backv�ater Prevention Device rebate amount will b� deducled from the final invoice <br /> given to the property ownc. for lhe installation at Ihe property address referenced above, if <br /> the total cost o(the installation is c�reater than the rebate. <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everelt will send a Federal Form 1099 MISC to me, the Vendor, (or Backwater <br /> Prevention Device rebate payments totaling more than 5600 per calenda•year, and will <br /> report Ihe same payments to tHe Intemal Revenue Service. <br /> I accept Ihe payment of lhe C�ackwater Prevention Device rebate from the City o(Everett pending <br /> approval of the completed Backtivaler Prevention Device rebate package by the City of Everelt <br /> 12�z 3/��/ <br /> Signature of Conlractor Date <br />