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i <br /> , <br /> i <br /> Backwater Prevention Device ' <br /> Rebate Program i <br /> i <br /> i <br /> Ver�dor Section (please print): ; <br /> p � <br /> �F_°2O � LiJvv� d�1N(C C_c..0 (�oQ� — ZS'' � Q/C� i <br /> �VP dor Name!Business Name/UBI Number � <br /> <nn�PC Pt�3 N 2 - i <br /> �ate of Washington Contraclor f ' ense Numbar: � <br /> C�'»c ��3? �`►�o�9amrs�- � . 5'82-�'/ � <br /> Vendor Malling�ddress City Stale Zip � <br /> �Ol� �(P ^0"I P-`� �'T2Crnvl"'Y�Ol1/f' F�' b�/,�f/e v. �'�-'�'r � <br /> Phone Email � <br /> ; <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check direcUy <br /> for the installation referenced a[the Property Acldress. By agreeing to receive the rebate <br /> check directly, I agree to the following: �. <br /> 1. The Backwater Prevention Device rebate amour�t will be deducted from the final S <br /> invoice given to the Property Owner for the installation at the Property Address � <br /> re(erenced above, if the total cost of the instal(ation 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 Fortn 1099 MISC to me, lhe Vendor, for i <br /> the Backwater Prevenlion Device rebate payments totaling rnore than $600 per <br /> calendar year, and will report the same paymenis to the Internal Revenue � <br /> Service. <br /> ; <br /> i <br /> I accept the dir�ct payment of the BacFvuater Prevention Device rebale irom the City � <br /> of Everett pendiny approval of fhe completed Backwater Prevention Device rebale � <br /> package by lhe Cily oi Everett <br /> i <br /> ! <br /> �� - �/ � � � ' <br /> � i <br /> Signafure o/Contr.3r.for Dafe � <br /> i <br /> i( <br /> f <br /> ! <br /> i <br /> ! <br /> � <br /> I <br /> Page 2 012 � <br /> Revised 9l3/2014 � <br /> i <br />