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ContracEor Section: <br />wrci �o /�U�^�f, rv �xi <br />Vendor Name / Business Name / UBI Number <br />/¢' �a/�/�L G JGl <br />State of Washington Contractor License Number: <br />i <br />S�/c7 7�s Avt� n//� M��ycvii:e wR j�sti7� <br />Vendor Mailing Address City State Zip <br />��iz s) 3 fi 7 /Sc 7 <br />Phone Einail <br />1, the Vendor, agree to receive th�- gackwater F'revenlion Device reba[e check dire.;lly for the <br />installalion at lhe above re'erenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Device rabate amount will be deduc(ed from the final invoice <br />given to the property owner (or the installation at the property address referenced above, ii <br />the total cosl of the inslallation is greater lhan the rebale. <br />2. I, the Vendor, am a Washinglon Slate licensed contraclor. <br />3. The City or Everetl wili send a Federel Form 1099 MISC to me, the Vendor, for Backwater <br />Prevenlion Device rebate payme�ts lotaling more than $600 per calendar year, and will <br />report the same payments to the Intemal Revenue Service. <br />I accept the payment of the Back�valer Prevention Device rebate from the Cily of Everett pending <br />approval oF the completed E3ack�vater Prevention Device rebate package 6y the Cily of Everett <br />-' /_7 <br />��_JJ . 1 �/`3c//� <br />Signature of Contractor Date <br />