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� <br /> Corr?ractor Section: <br /> /�P��i� �iw� ,� ---(�3 G13 G� I <br /> Vendor Name/ Business Name/ UBI Number <br /> i <br /> ����1����t1 - -- - - - -- - - <br /> State of Washington Contractor License Numbec <br /> S�/G� 7/f~/9"G N/ /"rGriYSVr'i/Ci Wp %37�/� l <br /> Vendor Mailing Address City State Zip <br /> 387 -�SG7 <br /> Phone Email <br /> I <br /> I, the Vendor, agree to recerve the Backwater Prevention Device rebate check direcUy For Ihe <br /> installation at the above referenced property address. By ayreeing to rer,eive the rebate check <br /> directly, I agree ro lhe following. <br /> . I <br /> 1. The Backwater Prevention Device rebate amount will be deduc�ed from the final invoice � <br /> glven to fhe property owner for the installation at the property address re(erenced above, if <br /> lhe lolal cost ot the�installalion is greater than the rebate. <br />', 2. I, the Vendor, am a Washinglon State licensed'contrector. <br /> 3. The Cily o( Everett will send a Federal Form 1099 MISC.to me, the Vendor, for Backwater <br /> Prevenlion Device rebale payments totaling more than 5600 per calendar year, and will <br />' rcoort the samc paymenis lo the Inlemal Revenue Service. <br /> I accept the payment o(the Oackwater Prevenlion Device reba±e from the City of Everelt pending <br /> approval of the completed Backv✓aler Prevenlion Device rebate package by ihe City o(Everett <br /> - _���rl�S" <br /> Signature of Contractor Date <br />