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1 <br /> •' 3 <br /> i� <br /> 'i <br /> 3 <br /> Contractor Section: <br /> Vendor Name I Busine s Name I UBl Number <br /> k <br /> e <br /> A <br /> State of Washington Contractor License Number: <br /> I <br /> i <br /> 024o L- <br /> �• '"t <br /> Vendor Mailing Address City State Zip I <br /> s <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 :s <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. 1, the Vendor, am a Washington State licensed contractor. <br /> S <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 k. <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett e: <br /> la /16 <br /> a <br /> Signature of Contractor Date <br /> z <br /> 3 <br /> i <br /> S <br /> 1 <br />