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Contractor Section: <br />� <br />/,�Y• U�Li�M��NG (�.> —<i!> -ciSSl <br />Vendor Name I Business Name / UBI Number <br />, <br />I' liL.��'L, S7c> ; L i <br />State of Washington Contrac;or License Numb2r. <br />�G1 ]_L� /�Vi% /1/L N1%3)i�s�%<_�L✓�%__Z�S_^, li <br />Vendor Mailing Address Ciry State 7_ip <br />„�.1.. - �rlS ''%�CJ7 _ <br />Phone Email <br />i, the Vendor, agree to receive fhe Backwat�r Pravention Devica rebate check direclly for Ihe <br />i��stalla?ion �t the above referenced proper�y address. By agre�ing ;o receive the rebate chec�c <br />direcUy, I agree to the following: <br />1. The 8ackwater Prevzntion Device rebate arriount �vill be deduc!ed from tne final involc= <br />given to the property o�vner for the installation at the nroperry address rererenced a6ovn, ii <br />the total cost of the installation is oreater than the rebaie. <br />2. I, the Vendor, am a Washington Slate iicensetl conlractor. <br />3. 'fhe Cily of Everett will send a Federal Form 1099 MISC to me, fhe Vendor, ior Backv.�ater <br />Prevention Device rebate payments totaling mors than 5600 per calendar year, and will <br />report the same payments 'o Ihe Internal Revenue Service. <br />I accept ,he payment of the Backwater Prevention Device rebate irom ,he City of Everett pending <br />approval of ti?e completed Backvialer Prevention Device rebate package by the Cily o( Everett <br />�� � � <br />SignaWre of Contreclor -... Date <br />