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Contractor Section: <br />/� I'�LL�U�Lld. i+��L .v' (�.>' — �/ � - ci S � <br />Vendor Name I Business Name I UBI Number <br />�11 L� �`''Ly�%� L�J — <br />Staie of Washington Contractor Llcense Number. <br />r <br />Vendor Mailinq Address <br />`� � ��(�%'l�C!7 <br />Phone <br />' Email <br />City Slate Zip <br />I, fhe Vendor, agree to receive Ihe �ack�vater Prev�ntion D2vice iebate check direclly for the <br />inslallntion at the abova reierenced property address. By agreeing to reczive the rebate check <br />direclly, I agree to the foilo�ving: <br />1 The Backwater Prevention Device rebale amouM tvill be deducted irom the final invoice <br />aivan to lhe property o��rner for ihe inslallation at ihc properiy nddress referenced above, ii <br />ti•e total cost of Ihe installation Is areater than the rebate. <br />2. I, the Vender, am a Washington State hc^nsed contractor. <br />3 The City of EvereB v�lll send a ��deral Form 1099 NISC to me, thc� Vendor, for Backe•:�L;r <br />Prevention Device rebale payments tolaling more than Su00 per calendar year, antl ivill <br />report lhe sai�e paymenls to 1he Intemal Revenue Service. <br />I ar.cept the payment o( the Backwater Prevenfion Device rebato from lhe Cily of [verett pendiny <br />approval of the completed Backwaler Prevention Device rebato pacicage by the Ciiy o( Everett <br />; � _ �� I;-_+ � <br />Signature oi Contraclor _ Date <br />