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Contractor Section: <br />�--re'z -�� <br />-G-9-�' .��� l�'D //i�(� --- <br />Stafe of Washington Conlractor License Number. <br />�(a ll VlSfa.✓a,v�-�,_�g-�t�- �2-T- Gn�t-- 9d'Z- o$ <br />Vendor Mailing Address Cily State Zip <br />�j—U/Z� <br />I, the Vendur, agree to receive the Backwater Prevention Device rebate check directly tor lhe <br />instaliation at the above re(erenced property address. By agreeing to receive lhe rebate check <br />direcUy, I agree to lhe following: <br />The Backwater Prevenlion Device rebate amounl will be deducted from the final invoice <br />given to the properly owner for lhe installalion at the property address referenced above, if <br />the to�al cost of the installation is greater than the rebate. <br />The City of Fverett will send a Federal Form 1099 MISC lo me, ihe Vendor, for <br />Prevention Device rebate paymenls totaling more than $G00 per calendar year <br />report lhe same paymenls to lhr Inlernal Revenue Service. <br />I accept the payment of the Backwater Prevention �evice rebate frorn Ihe Ciry af Everetl pending <br />approval of the completed Backwater Prevention Device rebale packaye by Ihe Ciry of Everell <br />� �-L <br />J � <br />