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Con#ractor Sec�tion: <br />-, . <br />� r,���L.� i� �/�. �'1 j�� �� __ � > -- �% � � C,� S � <br />Vendor Name I Business Name / lJBI Number <br />� �' L.� f�% S�� �,� <br />Stat� of Washington Contracfor License Number: <br />�`�l�z "7✓s'~,.4V� 11J� N1/i�� S�S Lfy�-�,�% �1��'/� �5'� �� <br />Vendor Maifing Address City State Zip <br />."� , �' _ �-'i�� � <br />Phone ` Email . T <br />I, �he Vendor, agree to receive th� Back�vater PrevQntion Devics re�ate cneck directiy for th2 <br />instafiafion at t�e abave referenced prapeRy address. By agr�eing to receive the rebate check <br />directly, I agree to the follo�ving: <br />1, The Backtivater Prevantian Device rebate amount will be deducted r'rom the final invoice <br />given to the praperty owner for the ins.atlation at the property address reTerenced above, ir" <br />the toial cost of the installation is greater than the rebate. <br />2. f, the Vendor, am a Washington State licensed contractor, <br />3. The City of Ever�it wil! send a Federaf Form 1099 MfSC to me, the Vendor, for Bacic�vate; <br />Prevention Device rebate payinents totaling more than $600 per cal�ndar year, and wili <br />report the same paymants to the Internal Revenue Service. <br />! accept fhe payment of the Backwatar Prevention Device rebate from the City ofi Everett pending <br />apnroval of the con-ipleted Backwater Prevention Device rebafe package by the Ciiy of Everett <br />Signature of Contractor <br />` �� <br />Date <br />