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• 8 <br /> 3 <br /> 3 <br /> x <br /> 3 <br /> 3 <br /> i <br /> i <br /> Contractor Section: <br /> Vendor Name/Busine s Name/ UBI Number <br /> 5 2 I <br /> State of Washington Contractor License Number: <br /> 4 <br /> CL <br /> r <br /> Vendor Mailing Address City State Zip <br /> Phone Email <br /> c <br /> I,the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> a <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given to the property owner for the installation at the property address referenced above, if 4 <br /> the total cost of the installation is greater than the rebate_ <br /> k: <br /> 3 <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> i <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 than $600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending t <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> i <br /> C� <br /> Date <br /> Signature of Contractor <br /> i <br /> 3 <br /> 3 <br />