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II <br /> 3 <br /> r <br /> Contractor Section: <br /> F <br /> Vendor Name I Busine s Name/ U131 Number <br /> State of.Washington Contractor License Number: <br /> i3O L actin F) 91Eve, qac <br /> Vendor Mailing Address City State Zip <br /> azala (Inc) <br /> Phone Email <br /> 1, the Vendor,agree to receive the Backwater Prevention Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> L <br /> directly, I agree to the following, <br /> 3 <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. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 10gg MISC to me,the Vendor, for Backwater g <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 /> t <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 /> Signature of Contractor Date <br /> I <br /> 1 <br /> x <br /> l <br /> 3 <br /> 3 <br /> a <br /> s <br />