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d <br />Conbractor Sectlon: � <br />Ven;ior Name / Busi <br />603 089 164 <br />State of Washinpton <br />900 Meridia� Ave E <br />Vendor Mailing Add <br />Phone <br />Name 1 UBI Number <br />License Number. <br />Email <br />Mllton WA 98: <br />City State Zip <br />I, fhe Vendor, agree to r e the Backwa�er Prevention Device rehate chedc directly for the <br />insteiatan at the n6ove rof renced properiy address. By agreeing to recehre the rebate check <br />direcdy, t egree to thc foll ing: <br />S. The Backwel0r Pr ntfon Deviee re6ate emountwiil bs deduded from the final i�voice <br />glven to t6eprope ownor forthe installatian at fhe property eddresa referencad above, if <br />Ihe total wst of the nstellaUon is greator than the rebate. <br />2. I, the Vendor, am a ashington State licensed cnntrector. <br />3. Thb City of EvercH ill send u Federal FoRn 1099 MISC to «�e, the Vendot, for BaCkwater <br />Preventbn Devke bate payments totaling more than b600 per calxnder year, and wili <br />repoA the same pa ments to ttie IMemal Revenue Service. <br />I eccept Ihe pttyment of th t3ackwater Prevontbn Device re6ale (rom the City oi Everett pending <br />approvel of the cnmpleted Backwater Prevenfion Device rebete package by lhe City.ot Evarett <br />�i8�f <br />Signature of <br />Dale <br />� <br />� <br />