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Contractor Section: <br />.. � <br />,; -, � <br />Vendor Name I Busine s Name / UBI Number <br />�� a'� ""¢" r' �� ?� l�P� � � l�-'" <br />�-�-'-L--r� �v_ — <br />State of Washington Contractor License Number: <br />Vendor Maifing Address <br />Phone <br />Email <br />City State Zip <br />!, the Vendor, agree to receive the Sackwater Prevention Device rebate cheek directly far the <br />ins#alfation at the abave referenced prope�ty address_ By agreeing to receive the rebate check <br />directly, 1 agree to fhe fallowing: <br />1. The Sackwater Prevention Device rebate amount will be deducted fram the final invoice <br />given to the proper�y owner for the instalEation at the property address referenced abave, if <br />the total cost ofi the installation is greater than ihe rebate. <br />2. I, Yhe Vendor, am a Washingtan State licensed contractor. <br />3. 7he City of Everett will send a Federal Form 'l099 MISC to me, the Vendor, for Sackwater <br />Prevention Llevic� rebate payments totaling more than $6�0 per cafendar year, and wi{l <br />report the same payments to the Internal Revenue Service. <br />! accept the payment of the Backwater Prevention Device rebate fram the City of Everett pending <br />approval af the cvmpleted Backwater Prevention Device rebate package by the City af Everett <br />� <br />Signature of Cantractor <br />� <br />Date <br />