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Contractor Section: <br />Vendor Name / Busine§s Name / UBI Number <br />,��--�" --►� �� ��� � ��� I � � <br />Sta#e of Washington Coniractor L.icense Number: <br />� ��-y�, �.. �, � l�� � . '� �'�-r �"iN" �� �����%� <br />Vendor Mailing Address City State Zip <br />Pt�one Email <br />I, t€�e Vendor, agree to receive #he Backwater Prevention Device rebate chec{c directly far the <br />installa#ion at the a6ove referenced properEy address_ By agreeing to receive the rebate check <br />directly, f agree fo the folfowing: <br />1. The Backwater Prevention Device rebate amount will be deducted fram the final invoice <br />given to the proper�y owner for the installation at the property address referenced above, if <br />the total cost of the installation is greater than tne rebate. <br />2. !, the Vendor, am a Washington State licansed contractor. <br />3. The Ciiy of Everett wilf sencf a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device re�ate payments totaling more than $�00 per calendar year, and will <br />report the same payments to the Interna! Revenue Service_ <br />I accept the payrr�ent of the Backwater Preventian Device rebate from #he City af Everett pending <br />approvaf of the completed 8acicwater Preventiort Device rebate package by the City of Everett <br />� <br />Signature of Contractor <br />x� � � <br />Date <br />