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3 <br /> .I <br /> Contractor Section: <br /> i <br /> Vendor Name! Busine s Name/ UBI Number <br /> State of Washington Contractor License Number: <br /> Q&c4v Lar <br /> r <br /> Vendor Mailing Address City State Zip <br /> Phone Email <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 /> directly, i agree to the following: <br /> 9. 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 <br /> the total 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 Federal Form 1o99 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 /> 1 accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> Signature of Contractor Date <br /> 1 <br />