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Contractor Section_ <br />Vendor Name 1 Busi <br />Name ! UBf Number <br />� �`'� _ �_ `~i'�i � ��� %- <br />5tate of Washington Cantractor License Number: <br />� _...___S�� - � <br />Vendor Mailing Address City State ZjP <br />.� <br />Phane "- Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly #or the <br />installation at the �bove referenced praperty address. By agreeing to receive the rebate chack <br />directly, i agree to the fo![owing: <br />1. The Backwater Prevention Device rebate amount wikl be deducted from the final invoice <br />given #a the prop�� pst ��ation is greater�than the rebate e�y address referenced above, if <br />the tota! cost of <br />2, l, the Vendor, am a Washington State licensed contractor. <br />3. The City of Evere�t wili send a Federa! Forrn '1099 MISC to me, the Vendor, for Backwater <br />Prevention Dev'sce rebate po the 1nte�nal�Re enue Servicea per caiendaryear, and will <br />report the same payment <br />I accep ett ph ayment of the Backwater Prevention Device rebate from the City of �verett pending <br />approvai of the completed Backwafer Prevention Device rebafe package by the City of E�erett <br />� <br />Signature of Gontractor <br />����� <br />Date <br />