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Contractor Section: <br /> � <br /> �����������--T/G��-�� ; <br /> Vendor Name!�usiness Name/ UBI Number <br /> � �tis���"-� f�i`� '� �!., � <br /> S#ate of Washington Cantractor l.icense Number: <br /> 'Zr.1� I� ��� �-���:��-__ �S ���1-1�����1 �v`�- ��s��� <br /> Vendor MailEng Address City Stafe Zip <br /> , � <br /> � `�-.� - � �- :..� f� ���.� c:� -��������`/��-� , �� <br /> Phone �mai1 <br /> t,the Vencior, agree to receive#he Backwater Prevention Deviee rebate check directly for the <br /> instaklation at the above referenced property address. �y agreeing ta receive the rebate ch�ck <br /> directly, I agree to the following: <br /> 1. The Hackwater Prevention Device rebate amount will b�deducted from the finai invalce <br /> given to the property owner fnr the installation at the property address referenced abave, if <br /> the total cost of fihe installatian is greater than the rebate. <br /> 2, f, the Vendor, am a Washington State ]icensed contractor. <br /> 3. The City of Eu�rett will send a Federal Farm 1099 MiSC#o me, the Vendor,for Backwater <br /> Prevention Device rebate paymen#s totaling more#han $600 per calendar year, and wi{I <br /> report the same payments to the Internal Rewenue Service. <br /> I accept the payrnent of the 8ackwater Preven#lon Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> � �/,I� <br /> � <br /> f <br /> Sign e Contractor Date <br />