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f <br /> 4 <br /> i <br /> I <br /> 3 <br /> f <br /> t <br /> 3 <br /> x <br /> Contractor Section: '= <br /> CJ'S PLUMBING&SERVICE LLC/602 950 117 j <br /> s <br /> Y <br /> Vendor Name/ Business Name / UBI Number <br /> CJSPLPS915OD <br /> State of Washington Contractor License Number: <br /> ii <br /> 5528 218TH AVE NE GRANITE FALLS WA 98252 <br /> f <br /> Vendor Mailing Address City State Zip <br /> ;r <br /> i <br /> 360-691-5159 CJSPLUMBING@MSN.COM r <br /> Phone Email <br /> t <br /> i <br /> i <br /> 9. <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the i <br /> installation at the above referenced property address. By agreeing to receive the rebate check <br /> directly, I agree to the following: <br /> ' <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice 3 <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 /> a <br /> 2. I, 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 <br /> a <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 Dale <br />