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ContracCor Section: <br /> ���c7_`ir���T,-r)-4�ir1E'� � Y�.GLC, i:���S <br /> IVendor Name/Busin:;ss Name/U81 Number <br /> �}�1--�-��f KI <br /> Slate of Washington Contraclor License Number: <br /> �1�= l..�zr��,��« Ei r�tF (�fl ���`.3 <br /> Vendor Maiiing Address City State Zp <br /> �'.l�- .��fr - ;ir'�.�:�-- C�'�r��'� c• �r�c��S�ay�J��id�. •���� <br /> Phone Email <br /> 1,tlie Vendor,agree to receive the Backwater PrevenGon Device rehale check directly for tne <br /> installation al the above referenced property add�ess.By agreeing to receive the rebale check <br /> � directly, I agree to the tollowing: � <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given lo the property owner fod the inslallaGon at the property address referenced above,if <br /> tho fatal cost of tho inslallation'is grealer than the rebete. <br /> 2. I,the Vendor,am a Washingto�State licensed conlraclor. <br /> 3. The City of Everett will send a Federal Fortn 1099 MISC lo me,ihe Vendor,for Backwater <br /> � Preventlon Device rebate paymenis to�aling more Ihan$600 per calendar year,and wiil <br /> reporl the same payments to the Intemal Revenue Service. <br /> I accept ihe payment af the Backwater Prevenlion Device rebale from the Ciry oi Everett pending <br /> approval of 1he completed Backwatr.r Prevenlion Device rebate package by Ihe City of Evemit <br /> �� �z �� --�-�-`�-- <br /> SignatUre of Gontrac�or Date <br />