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Contractor Section: <br /> G..z�s ��1�� ,�- P��,,.,b������?�' <br /> Vendor Name/Business Name/UBI Number <br /> /�-� J���I�'OY/�/� <br /> State of Washington Contractor License Number: <br /> � l/ /S'�it r.c�� f�1F S'�� �'�-� ��f'L� <br /> Vendor Mailing Address City State Zip <br /> 1jz)=ya�-o�z3 � 1�.�,b� [�c �y�'lr��t.�oy-� <br /> Phone Email <br /> I;the Vendor, agree to receive the Backwater Prevention Device rebate check directly tor the <br /> inslallation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to lhe following: <br /> L The Backtvaler Prevenlion Device rebate amount will be deducted from the final invoice <br /> given to the property owner for lhe installation at the prope.Ay address referenced above, if <br /> lhe total cos�of the installation is greater than the rebate. <br /> 2. I, lhe Vendor, am a Washington State licensed contractor. <br /> 3. The City o(Everett wiil send a Federal Form 1099 MISC to me, the Vendor, for Backwaler <br /> Prevention Device rebale payments tolaling more Ihan S600 per ca�endar year, and will <br /> report the same payments to Ihe Intemal Revenue Service. <br /> I accept the payment ot the Backwater Prevention Device rebate from Ihe City of Everett pending <br /> approval of lhe comple�ed Backwaler Prevention Uevice rebate packac�e by Ihe City of EvereU <br /> _La � � �� �=rs--�s' <br /> f <br /> Signature of Contractor Date <br />