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Contractor Secfion: <br />Vendor Name 1 Busi�e§s Name I UBI Number <br />� i�f � �� � �,� ��� 1 _� � <br />State of Washington Contractor License Number: <br />,��� �� � ���'i �, . ��i��-� �:� �' . ;� ��_ <br />Vendor Maifing Address City Sta#e Zip <br />-� � _ar � �: <br />Phone Emaif <br />I, the Vandor, agree to receive the Backwater Prevention Device rebate check direct[y for the <br />installation at the above referenced property address. 8y agreeing to receive the reba#e check <br />direc#ly, 1 agree to the foflowing: <br />1. The Backwater Prevention Device rebate arr;ount wilE be deducted fram the final invoice <br />given to the property owner for the instaliaiion at tF�e property address referenced above, if <br />the toEal cost of the installation is greater than the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett will send a Federak Form 'i 099 M15C to me, the Vendor, for Sackwater <br />Prevention Device rebate paymenks totaling more #han $6D0 per calendar year, and wili <br />report the same payments to the Ir�ternal Revenue Service. <br />i accepi the payrnent of the Bacicwater Prevention Device rebafe from the Cify of Everett penc4ing <br />approval of the compfated BacKwater Prevention Device rebate package by ihe City of Everett <br />� <br />Signature af Contractor <br />�� ��y �� <br />Date <br />