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i <br /> { <br /> i <br /> i <br /> jg <br /> i <br /> 1 <br /> Contractor Section: . 1 <br /> i <br /> i <br /> 1 <br /> Vendor Name I Busine s Name/ UBI Number <br /> A N KT 55 eoa K f <br /> State of Washington Contractor License Number: <br /> gtocto LarrViY1 nP�. EVer.-i" Lai q'SWO3 1 <br /> Vendor Mailing Address City State Zip E <br /> - /i i <br /> Phone Email I <br /> 1,the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive•the rebate check <br /> 1. <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given to the property owner for the installation at the property address referenced above, if <br /> the total cost of the installation is greater than the rebate. <br /> 2. I, the 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 Backwater <br /> Prevention Device rebate payments totaling more than$600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> i <br /> i <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> I <br /> d .__. t <br /> \ — i <br /> S \F 1 <br /> Signature of Contractor Date <br />