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Gontractor Sect�on: <br />� <br />Vendor Name / Busine�s Name I UBI Number <br />� � � � � ���� � <br />State of Wasf�ington Contractor License Number: <br />� ` . <br />��• ��_ <br />Vendor Mailing Address City State �ip <br />,���=�� ��ti �� �'w�.� � a c��� � � "�'r� ��r�r �. l` �,�� <br />Phone Email <br />1, the Vendor, agree to receive the Backwa#er Prevention Device rebate check directly for the <br />instailation at the above referenced property address_ By agreeing to receive the rebate check <br />directly, I agree to fhe fofiowing: <br />1. The Backwater Prevention Device rebate amount wiN be deducted from the final invoice <br />given to the properEy owner for the installation at the property address referenced above, ifi <br />the to#al cost of the instafiation is greater than the reba�e_ <br />2. 1, the Vendor, am a Washington Sfiate ficensed contractor. <br />3. The City of Everett will send a�ederal Form 1099 MISC fa me, ihe Vendor, for Back�nrater <br />Prevention Device rebafe payments #otaling more than $600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />( accepi the payment of the Backwater Prevention Device rebate fram the City of Evere�t pending <br />approval of the comp[eted Backwafer Prevention Device rebate package by the City of Everett <br />Signature of Contractor <br />r� l� <br />Date <br />