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�Backwater Prevention Device Rebate Program <br /> Rebate Submittal Checklist <br /> Submit your rebate packet within 90 days from the date the instaliation is inspected and <br /> approved by the city. Use this checklist to make sure that it includes all of the necessary <br /> materials. The items indicated (CONTRACTOR]will be provided to you by your contractor. <br /> Your rebate packet must include the following: <br /> Q Completed and signed Rebate Application Form (green) ' <br /> � <br /> � <br /> ❑ Completed and signed IRS Form W-9"Request for Taxpayer ldentification Number and ; <br /> . Certification"(white) <br /> QQ Vendor Payment Option Form(purple)signed by you and the contractor IF you want the <br /> rebate check sent to Ihe contractor. Otherwise, the rebate will be sent to you. <br /> � Completed Backwater Prevention Device Final Installation Checklist[CONTRACTOR� <br /> � Itemized invoice for the work, showing contractor name,address, license number and the <br /> detailed costs of installation and materials[CONTRACTOR]. <br /> � <br /> n Map of your property with location of ihe instalied device �CONTRACTOR) t <br /> When the packet is complete,maii or deliver it to: City of Everetl, Attn: BWPD Rebate � <br /> Program, 3200 Cedar Street, Everett,WA 98201. <br /> I <br /> C` <br /> f' <br /> � <br /> � <br /> � <br /> I <br /> � <br /> 1 <br />