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Contractor Section: <br /> �������.,�,� l��3 ��8�- lJ '� <br /> Vendor Name I Business Name!UBI Number <br /> �'��,���5 8'���S --- <br /> State of Washington Contractor LicenselVumber: <br /> ��_��.S�W h��t�s l.�A q�'oa6 <br /> Vendor Mailing Address City State Zip <br /> ��r�bS—�i�� .���a�e5������P-�C�'�<<<l,ca <br /> � <br /> Phone Email <br /> I,the Vendor, agree to receive the Backwater Prevention C evice rebate check direclly for the i <br /> installation at the above re(erenced propeAy address. By agreeing to receive the rebale check , <br /> dire�tly, 1 ayree lo lhe follo�ving: <br /> 1. The Backwaler Prevention Device rebate amount will be deducted from lhe final invoice <br /> glven lo the property owner(or Ihe installation at ihe property address reterenced above, il <br /> the total cost of the installalion is greater ihan the rebate. <br /> 2. I, the Vendor, am a Washinglon State licensed contraclor. <br /> 3. The City of Everott will send a Federal Form 1099 MISC to me, the Vendor,for Backwater <br /> Prevention Device rebate payments tolaling more lhan $600 per calendar year,and will <br /> report ihe same paymeNs lo the Intemal Revenue Service. <br /> I accept Ihe paymenl of the Back�vater Prevention Device rebate from lhe City of Everetl pending <br /> approval of the completed Backwater Prevention Device rehate package by Ihe Cily of Everett <br /> I p,,/�Li��'��/ 5-(�y�o�� <br /> Sig at e o(Conlraclor Dale <br />