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Contractor Section; <br /> 0 41(TJ 1/0-46- i M b! I V <br /> 71 <br /> endor Name/-Business Name/bBil Number - - <br /> State &Washington Contractor License Number: <br /> l GEIS Put <br /> �C <br /> Vendor Mailing Address City State Zip <br /> : 1 Y `IA' <br /> Phone Email <br /> 1,the Vendor, agree to receive tfib'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, 1 agree to the'followrlq:,, _.....A <br /> 1. The Backwater 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. 1,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 <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 accept the payment 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 /> Sionaturemof Contractor Y pate <br />