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Contractor Section: <br /> j .• <br /> 1 � <br /> d3 .. <br /> Vendor:Name;/Business N me.I:UBI Number." : <br /> State of Washington Contractor License Number: <br /> Vendor Mailing Address '`'• ' City State Zip <br /> .........:..::. <br /> Phone : <Emai <br /> i,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 /> directly, l agree to the following: <br /> '1. The.Backwwater 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 1. <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 /> p payment ,. ... <br /> l accet the 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 /> Signature of Contractor Date .. : :. :... <br /> 1 <br />