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Contractor Section: <br /> Vendor Name/Business Name I UBI Number <br /> State ot Washington Conlractor License Number. <br /> Vendor Mailing Address City State Zip <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly tor Ihe <br /> installation at the above referenced p�operty address. By agreeing lo receive the rebate check <br /> directly, I agree ro the following: <br /> L The Backwaler Prevention Device rebate amount will be deducled from ihe final invoice <br /> given to the property owner for the installation at the property address referenced above, if <br /> ihe total cost of the installafion is greater than the rebale. <br /> 2. I, the Vendor, am a Washinglon State licensed contraclor. <br /> 3. The City of Everell will send a Federal Form 1099 MISC to me,the Vendor, for Backwater <br /> Prevention Device rebale paymenls totaling more Ihan�600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> I accepl the paymenl of the Backwater Prevention Device rebale from Ihe City of Everell pending <br /> approval of the completed [3ackwa�er Prevention Device rebale package by the Cily of Everetl <br /> Signature of Contractor Date <br />