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i <br /> Contractor Section: <br /> j y -+3� f <br /> 3C74 <br /> Vendor Name 1 Busine s Name! UBI Number <br /> Ic a <br /> State of Washington Contractor License Number. <br /> Ve <br /> Vendor Mailing Address City State Zip = <br /> fine, - <br /> Phone Email <br /> i <br /> a <br /> I,the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the 5 <br /> installation at the above referenced property address_ By agreeing to receive the rebate check - <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, i <br /> i <br /> 2. I, the Vendor, am a Washington State licensed contractor_ t <br /> 3. The City of Everett will send a Federal Form 1 og9 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 <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett r <br /> a <br /> Date <br /> Signature of Contractor <br /> 3 <br /> 3 <br />