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Contractor Section: <br /> Vendor Name I Business Name/UBI Number <br /> State of Washington Conlractor License Number: <br /> Vendor Mailing Address City Stale Zip <br /> Phone Email <br /> I,the Vendor, agree to receive the Backwaler.Prevenlion Device rebate check directly for lhe <br /> inslallation al the above referenced property address. By agreeing to receive Ihe rebate check <br /> directly, I agree lo the following: <br /> 1. The Backwater Prevention Device rebate amounl will be deducled from lhe tinal invoice <br /> given to Ihe property owner for lhe installation at the property address referenceA above, if <br /> Ihe lotal cost of the installation is greatcr than the retiale. <br /> 2. I, the Vendor, am a Washington Stale licensed contrector. <br /> 3. The City of[verett will send a Federal Form 1099 MISG to me, lhe Vendor,for Backwater <br /> Prevention Device rehale payments lotaling more Ihan $600 per calendar year, and will <br /> report lhe same paymenls to ihe Internal Revenue Service. <br /> I accept Ihe payment of the Backwater Prevenlion Device reba�e from ihe City of Everett pendinc� <br /> approval of lhe completed F3ackwater Prevenlwn Device rebate package by the Cily of Everelt <br /> Signature of Contractor �ale <br />