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� <br />Backwater Pr�:venfiion Uevice <br />Rebate Program <br />Vendor Section (please pri�t): <br />Cra1`^ �,P7E—I.L S�LJ v�v3� I�.�% � N l. ��L 1 ��v I�1 <br />Vegdor Name ! B�siness Name / UBI Number <br />State of Washington Contractor License Number: <br />Vendor <br />Phone <br />Address , City <br />Email <br />ti / � �l �Z� (a <br />State Zip <br />� <br />,. �t�� iIS-,n���n.,h,.,.. .i <br />I, tne Vendor, agree to receive the Backwater Prevention Device rebate check directly <br />for the installation referenced at the Properly Address. By agreeing to receive the rebate <br />check directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final <br />invoice given to the Property Owner for ihe installation at the Property Address <br />referenced above, if the total cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, (or <br />the Backwater Prevention Device rebate payments totaling more than $600 per <br />calendar year, and w:�l report the same payments to the Internal Revenue <br />Service. <br />I accept the direcl payment of the Backwater Prevention Device rebate from the City <br />oF Everett pending approval of the completed Backwater Prevention Device rebate <br />package by the Ciry of Everett <br />Contractor <br />Revised 9/3/2014 <br />��.�� c-.'-�'-� <br />Date <br />Page 2 of 2 <br />