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� Contra�tor Section: <br />Vendor Nar�te / <br />Name / USl Number <br />� ��.-�-� ��-�--� � <br />State of Washingtan Contractor License Number <br />Vendor Maiking Address <br />Phone <br />Emaii <br />f.� <br />City State Zip <br />I, the Vendor, agree io receive the 8ackwater Prevention Device rebaie check directly for the <br />instaliation at the abo�e referenced property address. 8y agreeing ta receive the rebate check <br />directly, I agree to the fio{lowing: <br />1. The Backwater Prevention Device rebate amount wil( be deducted frorn the fnal invoice <br />given to the property owner for the instai[ation at the property address referenced above, if <br />the tatal cost of the instaliatian is greater than the rebate. <br />2, f, the Vendor, am a Washington State kicensed contractor. <br />3. The City of Everett wil{ send a Federal Form 1099 M1SC #o me, the Vendor, #ar Backwater <br />Prevention Device rebate payments tata{ing rnore thar� $Eb0 per calendar year, and wili <br />report the same payments to the Internal Revenue Service. � <br />1 accept the paymeni of the Backwater Prevention Device rebate from ti�e City of EveretY pending <br />approual of the compieted Backwater Prevention Device rebate packa�e by the City of Everett <br />� <br />Signaiure of Contractor <br />I� <br />� <br />�ate <br />