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Contractor Section: <br />Vendor Name I Busine�s Name I UBI Number <br />� � �- ��.� 7 �.. �� I � �. <br />State of Washingfon Contractor License Number: <br />� � � (� � � t''` ��- � �'��. �`,�:ii' �� �' �:���.-� <br />Vendor Mailing Address City State Zip <br />Phone Email <br />I, the Vendor, agree to receive the Backwater Prevenkion Device rebate check direc#ly for the <br />installation at the above referenced propetty address. By agreeing #o receive the rebate check <br />directly, i agree to the folfowing: <br />1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br />given to the properEy owner for the installation at the praperty address referenced above, if <br />the total cost of the installation is greater than #he rebate. <br />2. 1, the Vendor, am a Washington State licensed contractar. <br />3. The City of Everett wif! send a Fecieral Form 1099 MISC to me, the Vendor, far Backwater <br />Prevention Device rebate payments totaling more than $600 per calendar year, and will <br />report the same payments to the Interna! Revenue Service. <br />( accept the payment af the Backwater Prevention Device rebate from the City of Everett pending <br />approval of tf�e completed Backwater Prevantion Device rebate package by the City of Everett <br />� <br />Signature af Contractor <br />�� -� � ,� t � <br />Date <br />