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i <br /> Contractor Section: <br /> Vendor Nam�Busin& Name I UBI Number <br /> T e <br /> State of Washington Contractor License Number: <br /> Vendor Mailing Address City State Zip <br /> Phone Email <br /> i <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 /> directly, 1 agree to the following: <br /> invoice <br /> 1. The Backwater Prevention Devt�ereb�aea o�attheunt ipboperty addrese deducted s referenced eld ab ve, if <br /> given to the property owner.for <br /> the total cost of the installaton is greater than the rebate. <br /> 2. I,the Vendor, am a Washington State licensed contractor. ,c <br /> 3. The City of Everett will send a Federal Form 1099 MiSC to mee Venaoyear,r,forand will <br /> ackwer <br /> Prevention Device rebate payments totaling more than$600 per <br /> to the internal Revenue Service_ <br /> report the same paymentsEverett <br /> r <br /> I accept the paymentom of the ieted l3ackwaterPPeventiofon n Device lrebate prebate ackage byom the lty ofthe City of Evperettt,ng <br /> approval of the completed <br /> f <br /> Date <br /> Signature of Contractor <br /> I <br /> i <br />