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Contracto; Section: <br />/�r�il.L.�r�,Mi7�Nv (x�>' -�i 3 -�s�' <br />Vendor Nam� I Business Name / UBI Number <br />��i '� �'r;; <br />State oi Washington Contractor License Numter. <br />S` G 7/5 ~fl V.= NL /V7/�l � S�.$ ✓ill j �N/) �� rJ <br />Ven�or Mailing Address Cily Siate Zip <br />t�� � '�J—'l.�a7 <br />Phone " Email <br />I, the Vendor, agree to receive the Back�vater Prevention Device rebate check direcfly tor the <br />installation at ihe abovo reierenced property address. By ayraeing io receive the rebate check <br />directly, I agree to the tollo�aing: <br />1. The Backwater Prevenlion Device rebzte amount will be deducted from the final invoira <br />given to the property ownzr (or the insfallation at the property address referenced above, li <br />the .otal cost of the instailation Is greater than lhe rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The City of Everett v�itl send a Federal Form 1099 MISC to me, lhe Vendor, for Bacla�dater <br />Prevention Device rebate paymenis totaling mo�e than $6U0 per calendar year, and �vill <br />report the same oayments lo the Iniernal Revenue Service. <br />I accept the payment of the Ba�kv�ater Prevention Device rebate from ihe Cily oi Everett pendin,y <br />approval of ihe compleled Back�valer Prevention �evice rebate paGcage by the City of Everete <br />�� ' �J <br />Signature oFContraci�r _�_ Date <br />