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� <br /> Contractor SE:ct�on: . ' <br /> � <br /> �,.i� , ���cle. �c�lc�'�-� LL4 --.lv�'��'�� � <br /> Vendor Name I Busine s Name/UBI Number � <br /> ��j r �C'T ��5 �z r,�I _�,._� -- - <br /> Slate of,Washington Coniractor License Nurnber: <br /> �C7�_�-4L�i.�-�-�, ��✓�(�'t�' L����,'�p� <br /> Vendor Mailing Address Ciry State Zip <br /> ��aZ:Lo-a �L�� L'�Yld�_CLc:�_�,�3���.�rc1��-C-r.�i?2-- <br /> Phono Email � <br /> i <br /> _ - i <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the I <br /> installalion at the above referenced properly address. By agreeing to receive the rebate check I <br /> directly, I agree to the folio�ving: <br /> i <br /> 1. The Backwaler Prevention Device rebate amount will be deducted from the final invoice <br /> given lo the property owner for lhe instellation at the property address referenced above, if <br /> lhe total cost cf the installation is greater than Ihe rehate. <br /> 2. I,the Vendor, am a Washington State licensed contraclor. <br /> 3. The Cily of Everett will send a Federal Form 1099 MISC lo me, the Vendor, for Backwater <br /> Prevention Device rebate payments totaling more ihan$600 per calendar year, and will <br /> report the same payments to ihe Internal Revenue Service. <br /> I accept the payment of tho Backwater Prevenlion Devir.e rebate from th�City of Everelt pendinc� � <br /> approval of the compieled Back�vater Prevenlion Device rebate packac�e by lhe City of Everett ! <br /> � <br /> I <br /> �� -�> � ��___- `�--��-- <br /> Signature of Contractor Date <br />