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Contracto: 5ection: <br />G <br />Vendor Name / Business Name / UBI Number <br />_ A�oJ/�G 9a.3 G r <br />Slate of Washington Conlractor License Number: <br />_ S�/�� 7i �'" �}v�.vrr .��rYsv�ii�___w/i ��7a <br />Vendor Mailing Address City State Zip <br />("/.ZS� 3,rt7— iSo� _ <br />Phone Email <br />I, the Vendor, agree tn receive the Backwater Prevention Device rebate check directly fur the <br />installation at the above re(erenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the property owner for lhe installation at the property address referenced above, if <br />the total cost of the installation is greater than lhe rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Evere[t will send a Federal Form 1099 MISC to me, ihe Vendor, for Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />reporl lhe same payments to the Internal Revenue Service. <br />I accept the payment of the Backwater Prevention Device rebate irom the City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Everett <br />Signature of Contractor <br />1��3/ Zal,�`' <br />Date <br />