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Con#ractor Section: <br />��t���i� iJ���-.T/���-=�� <br />Vendor Name !�usiness Name / UBI Number <br />� �ti'�=-��� �� �� '�7 �: � <br />Stafie of Washington Contractor �.icense Number: <br />'�.1 � � � �t �-�'�c;���� �.S' �rb�1��rJ���l (��`� l�S�,`'llJ <br />Vendor Mailing Address City Siate Zip <br />[ ���� �' � �- :.� �, <br />Phone �mail <br />`C.�x����J�/c�� , <br />), the Vendor, agree to receive the Backwater Preventidn Device re�ate check directly for the <br />insfaklation at the above referenced proper#y address. �y agr�eing to receive the rebate check <br />directly, I agree to the foflowing: <br />1. The Backwater Preventinn D�vice rebafe amount will b� deducted from the finai invoice <br />given to the praperty owner for the i�stallation at the property address referenced abnve, if <br />the total cost o� the installation is grea#er than the rebate. <br />2, f, the Vendor, am a Washingtan State licensed contractor. <br />3_ The City of Eu�rett will ssnd a F'ederal Farm 1099 MISC to me, the Vendar, for Backwater <br />Preventidn Device rebate payments totaiing more tFran $60fl per calendar year, and wiU <br />repor# the same payments to the Internal Rewenue Service. <br />I accept the payment of the Backwater Preven#ion Device rebate €rom the City af Everett pending <br />approval af the completed Backwater Preventior� Device rebate package by the Gity of Everett <br />�i����� <br />Date <br />� <br />