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Contractor Section: <br /> Vendor Name I Business Name/ UBI Number <br /> State of Washington Contraclor License Number: <br /> Vendor Mailing Address City State Zip <br /> Phone Email <br /> I,ihe Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing �o receive ihe rebate check <br /> direclly, I agree lo ihe follawing� <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given to ihe property o�vner(or the installalion at the property address referenced above, if <br /> the total cost of the installation is greater ihan the rabate, <br /> 2: I, the Vendor, am a Washington State licensed contracfor. <br /> 3. The City of Everett wili send a Federal Form 1099 MISC to me, the Vondor, for Backwaler <br /> Prevention Device reba:e payments totaling more th�n 5600 per calendar ycar, and v.�ill <br /> report the same payments to the Internal Revenue Service. <br /> I accept Ihe payment of ihe Backwater Prevention Device rebale from !he City of[vere�t pending <br /> approval of Ihe compleled Backwaler PreveNion Device rebate package by the City of[verett <br /> Signature o(Contraclor Dale <br />