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Contractor Section: <br />Vendor Name I Business Name`I UBI Number <br />��1���`�- <br />State of Washington Contractor License Number: <br />�/ / �� '�Zt � <br />Vendor Mailing Address <br />_ ��'z � _�/C �i - 0/ <br />Phone <br />Email <br />City Slate <br />(�2 -'7�Z-� <br />I, thr. Vendor, agree to receive the Backwafer Prevention Device rebate check direclly for Ihe <br />installation at Ihe above referenced pwperty address. By agreeing to receive Ihe rebale check <br />direcUy, I 2gree to the lollowing: <br />1. The Backwater Prevention Device rebate arnounl wiU be deducted from �he t�nal invoice <br />given to ihe propeRy owner for the installation at the property address reterenced above, if <br />the total cosl of lhe installahon is greater than the rebate. <br />2 I, the Vendor, am a Washington Stale licensed cortreclor. <br />3. The City o( Everelt vrill sentl a Federal Form 1099 MISC to me, the Vendor. (or Backwater <br />Prevention Device rebate payments lotaling more than $600 por calendar year, and will <br />report �he same payments to the Intemal Revenue Service. <br />I accepl lhe payment of lhe Backwater Prevention Device rebate trom the City o( Everetl pending <br />approval of ihe compleled �ackwater Prevention Devir.e rebate package by the City of Everett <br />V <br />Sigi of Coniractor <br />�. i�.� �- <br />Date <br />