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i <br /> I ; <br /> t 4 <br /> a <br /> Contractor Section: <br /> A LL-C <br /> Vendor Name/Busine s Name I UBI Number ` <br /> 3 <br /> tStatQ - 1 <br /> Kt- <br /> State <br /> e of Washington Contractor License Number: <br /> Vendor Mailing Address City State Zip 3 <br /> Phone Email <br /> i <br /> 1, 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 i <br /> • <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 <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 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 /> ter Prevention Device rebate from the Cit of Everett pending <br /> I accept the payment of the Backwater Y 3 <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> 3 <br /> 9 <br /> t <br /> Signature of Contractor Date <br /> x <br />