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Contracfor Section. <br />Vendor Name / Busine�s Name 1 UBI Number <br />�� � ��� ��� � �'�� � � � <br />� r-,+-�-�— <br />State af Washington C�ntractor License Number: <br />�����_.� �� ��r � �� �' � �� �' ���'� <br />Vendor Mailing Address City State Zip <br />'.,r,�-,« <br />Phflne Emai1 <br />1, the Vendor, agree ta receive the BacEtwater Prevention �evice rebate check directly for the <br />installa#ion at the above referenced property address. 8y agreeing to receive the rebate check <br />directly, I agree ta the following: <br />1. The Backwater Prevention Device rebate amount wifi be deducted fram the final invoice <br />given to the property cawner far the insta[lation at the praperty address referenced abave, if <br />the total cost of the installation is greater than the rebate. <br />2. I, the Vend�r, am a UVashington State licensec! contractor. <br />3. The City of Everett will send a Federal Form 1099 MISC #r� me, the Vendor, for Backwater <br />Prevention Device rebate payments tataiing mare th�n $6qd per calendar year, and will <br />report the same payments to the Ir►ternal Rev�nue Service. <br />f accept the payment of the Backwater Preverition Deviee rebate from the City of Everet� pending <br />approvai of the cor��pleted Backwater Prevention Dsvice rebate pacfcage by tf�e Gity of Everett <br />Signature af Contractor <br />�-��`-��� <br />Date <br />