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Contractor Sec#ion. . <br /> .("� �y� /�.. - � r � (��'i�� �-^� 4...i �,lC-%-�� i^�4���� <br /> y-1•}L.�� . � . � <br /> Vendor Name/ Busine s Narne/ UBI Number <br /> � � � '�" �, � � � I �_�__---- <br /> State of W sa hingtan Contractor License Number: <br /> �. �. �`���'J(`�'"�` ��� �" , . �_. <br /> Vendor Mailing Address City State Zip <br /> ',�1-- ��. �'` � , �1 ` <br /> Phone Email <br /> !, the Vendor, agree ta receive the Backwa#er Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, ! agree to ti�e following: <br /> 1. 7he Backwater Prevention Device rebate amount will be deducted from the ffnal 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. I,the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett w'��Ila{en aa�en�tsrtotaling mo9e than $600 per calenda�year,and v�1�lf er <br /> Prevention Dev�ce re p y ; <br /> report the sarne payments to the lnternal Revenue Service. r <br /> I accept the payment of the Backwater Prevenfion Device rebate from the City of Everett pending <br /> approv�f of the completed 8ackwater Preventian Device rebate package by the Gity of Everett <br /> �, - � _ <br /> � _ � <br /> Signature of Contractor Date <br />