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f <br /> I <br /> 3 <br /> a <br /> 3 <br /> Y <br /> t) <br /> 4 <br /> Contractor Section: s <br /> a <br /> I <br /> �" Zf ' LLMC: - � �3- <br /> Vend or <br /> Vendor Name/ Busine s Name I UBI Number <br /> 1 <br /> A KI 5 5 S6, 1 K1-- - <br /> State of Washington Contractor License Number. <br /> i 1 <br /> Vendor Mailing Address City State Zip <br /> T <br /> coLo <br /> Phone Email <br /> s <br /> i <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 <br /> directly, I agree to the following: <br /> t <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. t <br /> 2. 1, 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 /> 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 <br /> f <br /> k <br /> Signature of Contractor Date <br /> 1 <br /> i <br /> tpt <br /> f. <br /> F <br /> i <br /> k <br />