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Contracto�� 5ectlon: <br />� <br />Vendor Name /8usines�Name I UBI Number <br />Stata ol `A�ashinyton Cuntrecloi License Number: <br />Vendor tilalling Addrass <br />Phone <br />` l�j�PC; 1,�1ct 7X �-T � <br />Gity Slatc Zip <br />Email <br />� �L�4-/Z. o CLN`� � <br />I, tha Vendo;, agree to recs_�ive the Ba:kK�ater Prevenlion Devlce robate check dlrectiy for tho <br />installation at the above referenced property address. By agreaing to reCelve the rebate check <br />dlrectly, I ac,ree to the fotlowing: <br />� 1. The Backwater Prevention DevlCe rebafo amount wtll �e deducled from Ihe finel mvcice <br />give�� to Uio property cw��ei tor the Instailal!on at �he properp� aAdress reforenced above, I( <br />the lo;al cosl of tl�e installation Is grea;er than Ihe rehale. <br />2. I, the Vendof. am a Washington Stale licensed conlracror <br />3. 7he Clty of Everett v+ill send a Federal Fo!m 1099 MISC to me, lhe Vendor, for 8ackwaier <br />Preven,ion Dev�ce rebate paymonls totaling more then Sfi00 Der calor,dar yeer, and will <br />rCport the Same payment� to the Intemal Revanur Service. <br />I accept the paymeN o( the Dackwater Prevontion Uevice reb�te from the City of Everolt pending <br />approval of Iho complelcHl Rackwalor Preventwn Devlce rabate paciage by the City of Evera;t <br />� <br />�,� �, �-�.y-'C �3' ��-��/7 <br />gneture of Contractor Dato <br />x <br />