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Contractor Section: <br />Vendor Name / Busine�s Name 1 UBI Number <br />� �► �- �; � ���.� � � _�. <br />State of Washingion Contractor �.icense Number: <br />Vendor Mailing Address <br />_ -._ x �. �.. <br />Phone <br />Email <br />City State Zip <br />I, the Vendor, agree to receive fhe Backwater Prevention Device rebate check directly for #hA <br />instailation at the above referenced property address. By agreeing ia receive the rebate check <br />directly, I agree to the following: <br />1. The Backwater Prevention Device rebate amount wifl be deducted from the final invoice <br />given to the proper�y owner for the instellation at the property address referenced above, if <br />the total cost �f the installation is greater than the rebate. <br />2. !, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett will send a Federai Form 1099 MISC to me, the Vendor, for Backwafier <br />Prevention Device rebate payments totaling more than $600 per cafendar year, and will <br />repori the same payments to the Internal Revenue Service. <br />! accept the payment of the Backwater Prevention Qevice rebate from the Cify of ��erett panding <br />approval of the completed Bac(cwater Prevention Device rebaie pacicage by the City of Everett <br />� <br />Signature of Gontractor <br />Date <br />� <br />