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-• Contractor Section: <br />Vendor Name � Busi <br />Namo! UBI Nwnber <br />�iLy4-��,z� `?-.'-�-1-��' - <br />Slate of Washington Contractor t_icense Number: <br />Vendor Mailing Address <br />iPhone <br />•_rnail <br />Gily Siate Z�P <br />I, the Vendor, agree lo receive fhe Backwater Prevention Deviee rebale check direclly for Ihe <br />installation al the above referrnced property address. f3Y a9�ee�ng lo receivc lhe rehate check <br />direclly, I agree to Ihe foilouing' <br />►i <br />3 <br />71ie Backwater Preveniion Device rebale amnunt will be deducted from Rie final invoice <br />c�iven to tha property owner for lhe installation at lhe property address reterenced above, if <br />the tolal cost of the inslallation is greater than the rehale. <br />I, the Vendor, am a Washington Stat� licensed conlrector. <br />Thc City nf Cverott will send a F�dcral Fann 1099 tJIISC to mc, lhc Vendor, (or S3ar,kwaler <br />Prevention Device rebate paymenls totaliny more ihan �600 per calendar year, and will <br />report the samc paymeMs to ihe Inlornal Revenue Service. <br />I accepl the p��Y�nenl ot the Backwaler Prevention Device rebate from ihe City of Cverell pendinq <br />�pProval of the compleled E3ackwater PreveNton Devir,e rebale pocka�e hy Ihe City of Everelt <br />/� <br />� �,,_-�� --7 -���--- <br />(����'_ � -- <br />Signature of Conlracror <br />Date <br />