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Contractor Section: <br />Vendor Name / Business Name / UBf Number <br />_��1/ul�'o//P/� - <br />State of Washington Contractor License Number: <br />� �� � �f � <br />Vendor Mailing Address <br />� <br />Phone <br />City <br />� <br />State Zip <br />��v� hf6? �C���''C��ni9zL:�C <br />Email <br />I, the Vendnr, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation al Ihe above referenced properh�� address. By agreeing to rea:ive lhe re6ate check <br />directly, I agree to the Toliowing: <br />1. The Backwater Prevention Device rehate amounl will be deducted from the finai invoice ' <br />given to ihe property owner for the Installation at the property address referenced above, if <br />the total cosl of the installation is grealer than ihe rebate. <br />2. I, the Vendor, am a Washington State licensed conlracior. <br />3. The City o( Everett will send a Federel Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rehale payments totaling more than $60D per calendar year, and will <br />report the same paymenls lo the Internal Revenuc Service. <br />I accept the payment of the Backwnter Prevention Device rebate from lhe City of Everetl pending <br />approval of the r.ompleted Backwalcr Prevention Device rebate package by lhe City oF Everett <br />��z� %�� ����� ���� 5 i <br />Signature of Contraclor Date <br />