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Contractor Section: <br /> y� 1I11 . <br /> Vendor Name I Business Name/U I Number <br /> ate of ashington Con ct r License Number. <br /> Wz <br /> Vendor Mailing Address,. Ci S#ate Zip <br /> R <br /> 7 r <br /> �"�� �' Lem`.� 1� (C� �� C�� � <br /> Phone Email <br /> I,the Vendor,agree to receive the Backwater Prevention Deuce rebate check directly for the <br /> Installation at the above referenced property address: By agreeing to receive the rebate check <br /> directly, I agree to the following: <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 /> 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 intemal 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 /> Sianature o on#ractor " Date <br />