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Ccntractor Section: <br />F� /� i� � tn 1^n (� i;'t <br />Vendor Name 1 Business Narrie / UBI Number <br />t�,9 n(Ur•Lc�/f�17 <br />State of Washington Conlractor License Number. <br />— %�� <br />dl CJI I /�� �7 /CI.l�GZil��L� i�/�1.� —IiC�%i%1 "l/l�� Cr�J �G l" V <br />Vendor P/�a�liog Address Ci(y State Zip <br />�..� Z-; _ <br />Phone <br />;'- O(Z'J <br />Email <br />�9lf'4�/ �L� <br />;,c �:. <br />I, Ihe Vendor, agree to receive the Backwater Prevenlion Oevice rebate check direclly for the <br />inslallalion at lhe above referenced property address. By agreeing to receive the rebate check <br />direcily, I ac�ree to the following: <br />1. The Backwater Prevention Devica rebale amount will be deducted trom lhe final invoice <br />given to the property owner for lhe installation at the properry address referenced above, if <br />lhe total cost of the inslallalion is greater than lhe rebate. <br />2. 1, the Vendor, am a Washington Stale licensed contractor. <br />3. The City of Everett wlll send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Preventlon Device rebate payments lotaling more lhan $600 per calendar year, and will <br />report Ihe same payments to Uie Internal Revenue Service. <br />1 accopt lhe payment of Ihe Backwater Prevention �evice rebate from the City o( Everefl pending <br />approval of the compteled Backwater Prevenlion Device rebale package by the City of Everett <br />i � �., � � <br />� r��� -- -, ; = f;` ��`-- �,. - / � � ( S -- <br />�-�� `" � ,' �" '� <br />Signalure of Contraclor Dale <br />