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i <br /> 3 <br /> 5 <br /> I <br /> ISE <br /> t <br /> f <br /> Y <br /> Contractor Section. 5 <br /> 3 <br /> i <br /> Vendor Name/Busine s Name/ UBl Number <br /> i <br /> i... <br /> A - KI- - <br /> State of Washington Contractor License Number: t <br /> Qlaa4v Lacko Dom. U <br /> Vendor Mailing Address City State Zip <br /> Phone Email t <br /> } <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the 3, <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following- <br /> 1. <br /> ollowing: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 i <br /> the total cost of the installation is greater than the rebate. # <br /> E <br /> f <br /> F <br /> 2. I, the Vendor, am a Washington State licensed contractor. <br /> t <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me,the Vendor,for Backwater 3 <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 /> 3 <br /> J� <br /> I 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 3 <br /> 7 <br /> Signature of Contractor Date <br /> r <br /> a <br /> i <br />