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- ��n�ra�ctor Sectic�n; <br />Vendor Name / Busine�s Name / UBI Number <br />��� � (r�! � � <br />State of Washingtdn �antractor License Number: <br />. <br />, �.� <br />L e � �'�.�'�� <br />V�ndor Mailing Address City State Zip <br />Phone Emat� <br />I, the Vendar, agr�e tp receive the Backwater Preventie�n Qevice reba�� cheek direcily fqr the <br />installatian at the above referenced property addres�. By agreeing ia reeeive the rebate check <br />directly, I agree to the following: <br />1. The Backwat�r Prevention i3euice rebate amount will be ded�cted from the final invoice <br />given to the properky owner for the ins#alfation at the proAerty address referenced above, if <br />ihe tatal cost of the instalfatRon is greater than the rebate. <br />2. 1, the Vendor, am a Washington State licensed contractor. ' <br />3. The City of Everetf will send a�edera) Form '1099 MI`SC to me, the VendQw, for Backwater <br />Prevention D�vice rebate payments tataling more than $600 per calandar year, and will <br />report the same payments to the lntemal Revenue Service. <br />I accept the payment of the �ackwater Preventian ��vice rebat� from the City of Everefii pending <br />approvaf of the complet�d Backwater Prewention Device rebaie package by the City of Everett <br />� <br />Signafure af Contract�r <br />� �- �� � �� <br />Dake <br />