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Backwater Prevention Device <br /> ErV r ; <br /> Rebate Program <br /> 3 <br /> Vendor Section (please print): <br /> C� <br /> Vendor Name /Business Name / UB1 Number r <br /> State of Washington Contractor License Number: I <br /> L <br /> t. 5_ <br /> Vendor Marlin <br /> 0 Address City State Zip <br /> la1-vlc. <br /> Phone Email <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly <br /> for the installation referenced at the Property Address. By agreeing to receive the rebate <br /> check directly, i agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final <br /> invoice given to the Property Owner for the installation at the Property Address <br /> referenced above, if 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 1099 MISC to me, the Vendor, for <br /> the Backwater Prevention Device rebate payments totaling more than $600 per <br /> calendar year, and will report the same payments to the Internal Revenue <br /> Service. <br /> 3 <br /> I accept the direct payment of the Backwater Prevention Device rebate from the City <br /> of Everett pending approval of the completed Backwater Prevention Device rebate <br /> package by the Qbyf Everett <br /> M 5L- <br /> Signature of Contractor Date <br /> F <br /> i <br /> n <br /> 3 <br /> x <br /> i <br /> E <br /> Revised 9/3/2014 Page 2 of 2 <br />