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Contractor Section: <br />� <br />Vendar Name I Busine�s Name I UBI Number <br />���� �� ��'.L.��--.-�r �. <br />State of Washington Contract�r License Nvmber: <br />Vendar Mailing Address City State Zip <br />_ �._ �c rr � -: <br />Phone Email <br />I, the Vendar, agree to receive the Backwater Prevention Device reba#e check directly for the <br />insfallation at the above referen�ed properEy address_ By agreeing to receive the rebate check <br />directly, ! agree to the following: <br />1. The Backwater Pre�ention Device rebate amount wiki be deducted #ram #he final invoice <br />given to the property owner for the installation af the property address referenced abava, if <br />the total cast of the installation is greater than the rebate_ <br />2, 4, the Vendor, am a Washington State iicensed contractor. <br />3. The Ciry of Everett wilf send a Federal Farm 1099 MISC to me, the Vendor, fflr Backwater <br />Prevention Device rebate payments totaling more than $600 per calenciar year, and wili <br />report the same payments to the I nterna! Revenue Service. <br />I accept the payment of the Backwater Preventian Device rebate fram the City of Evereit pending <br />appraval of the completed Bacfcwater 4'revention Device rebafe package by ths City of Everett <br />� <br />Signature of Contractor <br />� L <br />Date <br />