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Contractor Section: <br />•-�,-•uT—_ . <br />Vondor Name ! Busire. s Name / UBI Number <br />�. r - '� -�-��--i `-r <br />State of Washington Contractor License Number. <br />Vendor Mailing Address <br />Phone <br />Email <br />City State Z�P <br />I, the Vendor, agree to receive the Back�vater Prevention Device rebale check directly for Ihe <br />installation at Ihe 2bove referenced properiy address By agreeina to receive the rebale check <br />directly, I agree to the followmg: <br />1 <br />2. <br />3. <br />The Backwater Prevention Device rebate amount wlll be deducted irom the final invoice <br />yiven to the properfy owncr for the installation al the property address referenced a6ove, if <br />the total cost of 1he instaliation is groater than the rebate. <br />I, the Vendor, am a'PJashington State licensed con,ractor. <br />The Ciry of tverett wiil send a Federal Form 1099 MISC to me, ihe Vendor, fer Backwater <br />Prevention Device rebaie payments totaling more than $600 per calendar year, and v�ili <br />report the same payments to ihe Intemal Revenue Service. <br />I accept the paYment of lhe Backwater Prevention Device rebate from Ihe Cily o( Everett pendinc� <br />approval of the completed Backwater Prevention Device rebale package by Ihe Gity oF Evorett <br />Signature of Contractor <br />�� ��� <br />Date <br />