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Contractor Section: <br />Vendor Name I Busine�s Name I U81 Number <br />,� � �' � �',��� � <br />State of Washington Contractor License Number: <br />,� �' < <br />� 1��� ��. r �� � �i��-�...�. �... � ��� <br />Vendor Mailing Address City State �ip <br />.� <br />Phone Err�ail <br />1, the Vendar, agree to receive the Backwater Prevention �evice rebate check directfy for the <br />installation at the above referenced property address. By agreeing ta receive the rebate check <br />directly, l agree to the following: <br />1_ The BacEcwater Preventian Device reba#e amount will be deducted from the finai invoice <br />given to the property owner for the instalfation af the praperty address referenced above, if <br />the total cost of the instaflation is greater than the rebate_ <br />2. 1, ihe Vendor, am a WashingEon State iicensed contractor. <br />3. The City of Everett will send a Federal Form 1099 MiSC to me, the Vendor, for Backwater <br />Prevention Device rebate payments totaling more ihan $600 per calendar year, and will <br />report #he same payments to the fnternal Revenue Service. <br />I accept the payment of fhe Backwater Preveniion Device rebate from the City of Everett pending <br />approval of the completed SacKwater Prevention Device rebate package by the Gity af Evere�t <br />Signature of Contractor <br />� � <br />Date <br />