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Backwater Prevention Device <br />Rebate Program <br />Vendor Section (please print): <br />ISEATTLE DRAIN SERVICE 602830936 <br />� Vendor Name / Business Name I U61 Number <br />VSEATTDP936 _ <br />State of Washington Contractor License Number. <br />Vendor Mailing Addn <br />u�r, i'� us�L <br />Phone 206-632-8069 <br />City Slat� z�o <br />� i�.�� �� S��L3 <br />� <br />I, lhe Vendor, agree to receive the Backv�ater Preventicn Device rebate check directly for <br />the installation referenced at the Property Address. By agreeing to receive the rebate <br />check directly, I agree to the following: <br />1. The Back�vater Prevenlion Device rebate amounl �vill be deducted from the final <br />invoice given to the Property Owner for the installation at the Property Address <br />re(erenced above, if the total cost oi the installation is greater than the rebate. <br />2. 1, the Vendor, am a Washington Stale licensed contractor. <br />3. The City of Everelt will send a Federal Form 1099 MISC to me, the Vendor, for <br />the Backv�ater Prevention Device rebate payments totaling more than 5600 per <br />calendar year, and will report the same payments to the Internal Revenue <br />Service. <br />I accept the direct payment of the Backwater Prevention Device rebate (rom lhe City of <br />Everetl pending approval of tlie completed Backwater Prevention Device rebate <br />package by the Cily o( Everett <br />�� I\ <br />Signafure �( Ccntracto�� <br />Revised 91312014 <br />�' <br />�f--`� = t� - <br />Dafe <br />Page 2 of 2 <br />