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Backwater Prevention Device Rebate Program <br />�, E„ Rebate Submittal Checklist <br />51 ubmit your rebate packel �vilhm 90 days from the date the mstallation is mspected and <br />approved by the ciry. Use this checklist to make sure that it mcludes all of the necessary <br />� materials The items indicated jCONTRACTOR) e�ill be provided to you by your coniractor. <br />Your rebate packet must include the following: <br />%� Completed and signed Rebate Apphcalion Form (yreen) <br />� <br />� Completed and signed �RS Form W-9 "Request for Taxpayer ldentification Number and <br />Certification" (�vhite) <br />� 1 Vendor Payment Oplion Form (purple) siqned by you and the conUactor IF you a�ant the <br />/ rebale check senl to the contraclor O�her�vise, the rebate will be sent to you <br />� Cumpleted Back�vater Prevention Device Final Installation Checkiist [CO�TRACI'OR] <br />�,�Itemized mvoice tor the work, sho�ving contractor name, address, license number and ihe <br />detailed costs of installa6on and materials [CONTRACTOR). <br />y j 4dap of your property wilh location oF the installed dewce [CONTRACTORj <br />/ <br />When the packet is complele, mad or deliver it tu i.ity of Everett, At1n: RWPD Rebate <br />Program, 3, 00 Cedar Sireet, Everett, WA �J8201 <br />