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Contractor Section: <br /> �tA►v�P�Ei�'S P(.���+gin�h I n�c . ' �62 �2..(0 �q�{ <br /> Vendor Name/Business Name I UBI Number <br /> C �Pr.�z a�z w� 5 <br /> State of Washington Contractor License Number: <br /> p_�: (�o� S�.-1 � �',,�.P�:,r— wY°� ��SZ��� <br /> Vendor Mailing Address! City State Zip <br /> �S--ZS�-��[`�b� �a,�d�ceaCa,•�belts-Al��,bw�<<a;� <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 /> diredly, I agree to the Following: <br /> 1. The Backwater Prevention Device rebate amount will be deducled irom the final invoice <br /> given to ihe property owner tor the installation at the property address referenced above, if <br /> 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 Cily of Everett will send a Federal Form 1099 MISC to me, lhe Vendor,for Backwater <br /> Prevention Device rebate payments totaling more than $600 per calendar year, and will <br /> report the same payments to the Internal Rvl�enue Service. <br /> I accept the payment of the Backwaler Prevention Device rebate trom the City of Everetl pending <br /> approval of the completed Backwater Prevention Device rebate package by ihe Cily of Everett <br /> t,l q 2v� <br /> Signat of Contractor Date <br />