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Contractor Section: <br />Vendor Nai�e / Business Name / U81 Number <br />AM� (��--�W�LK� <br />State of Washington Contraclor License Number. <br />�ar�cY� �<<rl���� E� ��F (.�)fl �.��3 <br />Vendor Mailing Address City State 2ip <br />�Ci�("P.�•,r� --` � G.� " � CLt� �lC.�:i��.' <br />Phone Email <br />I, the Vendor, agree to receive the Back�vater Prevention Device rebale check direc(ly for lhe <br />installation at Ihe above referenced property address. By agreeing to receive lhr_ rebate check <br />directly, I aqr2e to lhe following: <br />1. The Backwater Prevention DeYice rebate amount will be deducted from the final invoice <br />given lo the property owner fo�the installation at the property address re(erenced ahove, If <br />the tolai cost of the installalion�is gmater Ihan the rebate. <br />2. I, Ihe Vendor, am a Washington Stale licensed coNractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, Ihr Vendor, (or Backwater <br />Prevention Device rebalr. paymr.nls tolaling more ihan 5600 per calendar year, and wili <br />report the same payments to the Intemal Revenue Service. <br />I accepi u,e payment of the Oackwater Prevention Device rebale Irom the City of Everett pending <br />approval of lhe compieted Backwaler Prevention Device rel�atr. package by ihe Cily of Evemtt <br />�/� : �� `� �j� <br />SignaNre ot Contraclor Date <br />