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Contractor Section: <br /> . �/�G/�G /li?iI�4 �x/3 G� � GS(,L.. <br /> Vendor Name!Business Name I UBI Number <br /> �4P�///�G �c�3� � <br /> � State of Washington Contractor License Number. <br /> _ S�/G7 �/fr A✓G NG" Mu/ytu.�� W9' -_-fy57JG <br /> Vendor Mailing Address City State Zip <br /> ��/Z S� ��i7 15�7 <br /> I Phone Email <br /> I,the Vendor, agree lo receive the Backwater Prevention Device mbate check directly for the <br /> instailalion al the above referenced property address. By agreeing lo receive the rebate check <br /> ! directly, I agrec to the following: <br /> 1. The Backwater Prevention Device rebale amount will be deducled from the final invoice <br /> given to the propeRy owner(or the installalion al the property address referenced above, ii <br /> the tolal cest of lhe installation is greater than the re6ate. <br /> 2. I,the Vendor, am a Washinglon State licensed contractor. <br /> 3. The City o(Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwaler <br /> Prevention Device rebate payments lolaling more Ihan$600 per calendar year, and �vill <br /> report the same payments to the Intemal Revenue Service. <br /> I accept the payment of lhe Backwaler Prevention Device rebate trom lhe C`ty of Everett pending <br /> approval of the compleled Backwaler Preve�tion Device rebate package by the Ciry of Everett <br /> I <br /> ��-- L2 2� /c <br /> i Signature of Contrador Date <br /> � <br /> rr <br />