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Contractor Section: <br /> <Oo�- e" - � <br /> _�<��--f� �i��'� � igr�- o%,r�hli2v�lC 9i r� �� � �3 7 <br /> '�ndor Name/Business Name/U81 Number <br /> _ �t�t l� l�l '�= d/l�t� <br /> State of Washington Coniractor License Number: <br /> ���// l/l S�ztl�2-in�Z f`�� ��,evu�1— Gc�r'9- �� o� <br /> Vendor Mailing Address City State Zip <br /> i{2J=�/B9 -G�73 ��-�1�,�,��„Z � r�.�a-v��'i�, r. c�� <br /> Phone Email <br /> I, the Vendor, agree to reoefve the Backtvater Prevenlion Device rebate check directly for the <br /> installafion at the above reterenced property address. By agreeing to recefve the rebate check <br /> directry, I agree lo lhe follovring: <br /> 1. The Baclaveter PrevenHon Device rebale amount will be deducted from the final invoice <br /> given to the property owner for the installation at the property address re(erenced above, iF <br /> lhe total cost of the installalion is greater than lhe r_hate. <br /> 2. I,lhe Vendor, am a Washington State licensed conlraclor. <br /> 3. The City of Everett will send a Federal Fortn 1099 MISC to me, the Vendor, for Backvrater <br /> Prevenfion Device rebete payments totaling more than 5600 per calendar year, and�viil <br /> report the same payments to tlie Intemal Revenue Service. <br /> I accept the payment of the BacMvatcr Prevention Devico rebale frnm lhe City of Fverelt pendin� <br /> approval oF the completed Backwater Prevention Device rebate package by Ihe City of Evaretl <br /> i <br /> - � �G� �-t2- i 5! <br /> Signature of Cont2ctor Dale <br />