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Contractor Section: <br />------ -- -- ----- --- -- - - -- — - <br />,� __��� ��-� �� �3 -.��5- ll � <br />Vendor Name I Business Name 1 UBI Num er <br />�b-5��s g`�•\�}-S— -- — -- — — <br />Slate of Washington Cor�h�tor License Num6�r. i <br />, <br />�-�� �..��� s� ��-- � �� � ��. 980�6 I <br />Vendor A4ailing Address City State Zip <br />���5'�119� ��s�iu-�e��6t��«;�s'��e�'�.�"u; j.c�� <br />Phone <br />Email <br />i, the Vendor, agree to receive lhe Bac4.�vater Prevenbon Device rebate check d�recUy tor lhe <br />mstallation al the above reterenced property address By agree�ng to receive lhe rebate check <br />direclly, I ayree lo the (ollawing: <br />t. The E3ackwater Prevenlion Gevice rebate amounl will he deducted from the final invoice <br />given to the property owner for �he installation al lhe property address referenced above, ii <br />the total cost of Ihe installation is greater than the rebate <br />2. I, the Vendor, am a Washmgton Stale licensed coMractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwaler <br />Prevention Device rebate paymenls totaling more than $600 per calendar year, and wlll <br />report ihe same paymeMs to the Internal Revenue Servir.e <br />I I accept the paymenl of the Backwater Prevention Device rebate from the City of [verett pending <br />approval of the completed Backwater Preventian Device rebate package by the Ciry of Everett <br />1 `�(,�( /"'"`�_� <br />, �n e of Conlractor <br />.3-I �-��;s <br />�3iP. <br />