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Contractor Section. <br />Vendor Name I Busine�s Name / UBI Number <br />1 j��\�� �- �l <br />��-t� � �� � � <br />State of Washington Contractar License Number: <br />r �ryl,� �... �, �" '�,�1,__� �T� � �� � '��-'-'�'�-`� '�,'" �� �' �r � ��` <br />Vendor Mailing Address City State Z�p <br />Phone Email <br />I, the Vendor, agree io receive #he Backwater �'reven�ion Device rebate check directly for the <br />installation at the above referenced property address. �y agreeing to receive the rebate check <br />directly, l agree to the foilowing: <br />1. The Backwater Preventian Device rebate amount wifl be deducted from the final invoice <br />given to the proper�y owner #or ihe installation ai the property adciress referenced above, if <br />the total cost of the installation is greater than the rebate. <br />2, I, the Vendar, am a WashingEon State licensed contractor. <br />3. The City of EveretE will send a Federaf Form 1099 MISC to me, the Vendor, far Bac4cwater <br />Prevention Device rebate payments totaling m�re than $600 per calendar year, and will <br />repot� fhe same payments to the Irtternal Revenue Service. <br />! accept the payment of the Backwater Preven�ion Device rebate from ihe City of Everett pending <br />approval of the completed Backwater Prevention Device rebate package by the City of Everett <br />� <br />Signature of Contractor <br />�. �.�. �_J_ <br />Date <br />