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i <br /> • i <br /> i <br /> 1 <br /> i <br /> Contractor Section: <br /> i <br /> Vendor Name I Busine s Name/ UBI Number <br /> i <br /> A1ERT55 & I Kt- 1 <br /> State of Washington Contractor License Number: I <br /> 1 <br /> Q6,Cv Lar ti l c P2. E.'k�er :l+ LDQ q?GO3 <br /> Vendor Mailing Address City State Zip <br /> r <br /> a -exioua)g3 airktr i c -g, , . 0. ( ' cc-vi) <br /> Phone Email <br /> 1 <br /> F <br /> I <br /> i <br /> i <br /> 1, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the I <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> 1 <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice i <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 /> i <br /> 3 <br /> i <br /> 1 <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending I <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> i <br /> x <br /> ae - •, <br /> Signature of Contractor Date <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> i <br /> S <br /> i <br /> 1 <br />