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.1 <br /> Contractor Section: . <br /> - �~ � �,z�- �-� ���=. ���-�.�'l`f_L�i�. r���� ,'��d�:.�� <br /> Vendor Name/ Busin�ame/ UBI Number <br /> ,� �_�_��. �� �, Y�� � __�_�_ <br /> State of Washington Contractor License Number: <br /> � <br /> '���yC� L--�,�` ls� �. �.��-�`t�-`t� _s���'��:�. <br /> Vendor Mailing Address City State Zip <br /> r '�'`)�'J� �7�, Cy:.�� , E��� � d <br /> Phane �mail <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at fhe above referenced property address_ By agreeing Eo receive the rebate check <br /> directly, f agree to the following: <br /> 1. The Backwater Prevention Device rebate amount wiil be deducted from the fina! invoice - <br /> given to the property owner for the installation at the property address referenced above, if <br /> the total cost af the instalfat[on is greater than th� rebate. <br /> 2. I, tha Vendor, am a Washington State ficensed contractor. <br /> 3. The City of Everett wif] send a Fed�ral Form 1099 MISC to me, the Vendor,for Backwater <br /> Prevention Device rebate payments totafing more than $600 per calendar year, and wili <br /> report the same payments to the Internal Revenue Service. <br /> 1 accept the payment of the Backwater Prevention Device rebate from the City of Everett pending ' <br /> approva! of the comple#ed Backwater Prevention Device rebate package by the Cify of Everett <br /> C�6 - . �j�`� <br /> � � :r��—�z._ <br /> 5igna#ure of Contractor Date <br /> i. <br />