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Contractor Section: <br />111 oen 63 - L-(G Gci <br />Vendor Name / Business Nam <br />/ UBI Number <br />M0e-"' PP-r $ S 3.) <br />J <br />State of Washington Contractor <br />License Number: <br />( 75 iS 41°r V Sr,-- <br />N <br />t✓b Ctmci0 <br />Vendor Mailing Address <br />City <br />State Zip <br />golf— -%L) U <br />i r�,•�J ��i Mou, <br />pla .h , .�� �. <br />Phone <br />Email <br />1, 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 />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final Invoice <br />given to the property owner for 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 Stale licensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC tome, the 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 Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Everett <br />Signature of Contractor <br />F-'-2 G -II- <br />Date <br />