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, ' <br /> Backwater Prevention Device <br /> Rebate Program <br /> Vendor Section (please print): <br /> SEATTLE DRAlN SERVICE 602830936 <br /> Vendor Name / Business Name/ UBI Number <br /> SEATTDP936 _ <br /> State of Washington Contraclor License Number: <br /> �V,ern�d��or M�Iail1ing Addre s �+ � � � State Q �� <br /> I�0-o'-v 11L�� � J 7� ' / <br /> i Phone 206-632-8069 il � ���l�f_�—���—'— <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebale check directly for <br /> the installation refe;enced at the Property Address. By agreeing to receive lhe rebate <br /> check directly, l agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from Ihe final <br /> invoice given to the Property Owner for the installation at the Property Address <br /> referenced above, if lhe total cost of the installation is greater than the rebate. <br /> 2. 1, lhe Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for <br /> the Backwater Prevention Device rebate payments tot2linq more than $600 per <br /> calendar year, and will report ihe same paymenls Yo the Internal Revenue <br /> Service. <br /> I accept lhe direct paymenl of the Backwater Prevention Device rebate from the Cily of <br /> Everett pending approval of the completed Backwater Prevention Device rebate <br /> package by the City of Everett <br /> <--\:���--� -- _��l�l/—�`-'��-) <br /> Signature o(C�ntractor Date <br /> Page 2 of 2 <br /> Revised 9l312014 <br /> � <br />