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Contractor Section: <br />e-Ac awe ��"CL t! LC • 6r,A� <br />9 <br />Vendor Name I Business Name / UBI Number <br />AMr <br />State of Washington Contractor License Number: <br />ffirn-4 <br />Vendor Mailing Address City State <br />Zip <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Deyice rebate amount will be deducted from the final invoice <br />given to the property owner fo i the installation at the property address referenced above, if <br />the total cost of the installat:on'is greater than the rebate. <br />2. I, the Vendor, am a Washington Stale licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MI SC tome, the Vendor, for Backwater <br />Prevention Device rebate payments totaling mom- than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the Clty of Everett pending <br />approval or the completed Backwater Prevention Device rebate package by the City of Evr:tett <br />o a <br />Signature cl Contractor Date <br />°e .C<0i7 <br />