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Contractor Section: <br /> _ Sewer �"r i I,,n L�-C � c� 0 2 �l3`� 78D <br /> Vendor Name/ Business Name/UBI umber <br /> Sewe�r- -� L�l l.e w� S <br /> State of Washington Contractor License Number: <br /> �(7 I�X �'�� L�'(1h1v0� � wl+ �g��� <br /> Vendor Mailing Address City State Zip <br /> _ZOIo 8q0 -f478 I�ie�Se,wer-Frienc��V,(�pm <br /> Phone Email <br /> I, the Vcrdor, agree to receive the Backwater Prevention Device rebate check direcNy for the <br /> installalion at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invo�ce <br /> given t�;;,P property owner for the installation at the property address referenced above, if <br /> the total cost of the installation is greater than the rebate. <br /> 2. I,the`Jendor, am a Washinglon State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 NiISC to me, lhe Vendor, for Backwater <br /> Prevention Device rebate payments totaling more than 5600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> I accept the payment of thP Sackwater Prevention Devise rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate oackage by the City of Everett <br /> ;���,�, �� f 2 �i 1 <br /> , — <br /> Signature of Coniractor Dafe <br />