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Contractor Section: <br /> �r'� ,'��rl va-`�T ��-04- p��r.� ����i «_� 6�z� �,i--7 3 <br /> Vendor Ivame 1 Business Name/ U61 Number -� <br /> � <br /> �- l�-.� b�v� �Plu l,�o i/P� � <br /> Stale of Washingfon Contra or License Number: <br /> 8� �� (/is�-zc.va�v� t�'G� �v�ua-s �..�►- 9e'L�' <br /> Vendor Mailing Address Ciry State Zip <br /> Q��� uB `� -- orz3 �-�I�Mb �� �c.c2-y��.�-7n,rt,,, .��,w� <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevenlio�, 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 Prevenlion Device rebale amount will be deducted from the final invoice <br /> given to the property owner for the inslallation at the property address referenced above, if <br /> the total cost oi the installation is greater than the rebate. <br /> 2 I, the Vendor, am a Washington State licensed conlractor. <br /> 3. The City of[verett will send a Federal Form 1099 MISC to me, the Vandor, for Backwater <br /> Prevention Device rebale payments totaling more than $60D per calendar year, 2nd will <br /> report the same payments to the Internal Revenue Service. <br /> I accept the payment o(the Backwaler Prevention Device�rebate from the Ciry of Everett pending <br /> approval of the completed Backwater Prevention Device rebate � ;- �ge by ihe City of Everett <br /> _l./������� .�/-�-lS'- <br /> Sigr,ature of Contractor Date <br /> � <br />