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Contractor Section: <br />� <br />Vendor Name / Busine�s Name / UB{ Number <br />,� � � �� ��� ���---� r <br />Siate of Washington Contractor L.icense Number: <br />� ��� L-. �, r l�'� �� � �� �-�LL� �r� � �::���=� <br />Vendor Maiiing Address Ci#y State Zip <br />` l� r �,�'' <br />�r� -.�� -��i �� �'� �'�;: c-�� a� � ��'��� (�r'� � <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check direct[y for the <br />installation at the above referenced property address. Sy agreeing to receive the rebate check <br />directiy, ! agree to the fol[owing: <br />1. The Backwater Prevention Device reba#e amount will be cfeducted from the final invoice <br />given to the property owner for the instalkation at tF�e prape�ty address referenced above, if <br />the tota{ cost of ihe installation is greater ihan the rebate. <br />2. I, the Vendor, am a Washington Sta#e licensed contractor, <br />3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater <br />Prevention Device rebate payments to#aling more than $600 per cafendar year, and will <br />repori the same payments to the lntemal Revenue Service. � <br />I accept the payment of the Backwater Prevention Device rebate from the City of Evefett pending <br />approval of the completed 8acicwater Prevention Device rebate package by the City of Everett <br />Signa#ure af Contractor <br />�✓ <br />D ate <br />