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Contractor Secti�n. <br /> �.� J�� '�� ��r�� � ��� ����� � 1..�. ���--_:�� °� <br /> Vendor Name/Business Name/UBI Number � <br /> � ,t,, <br /> .���'�"�-���_�.'`�,�°�`;�i''�„'��,,.? <br /> State of Washington Contractor License Number: <br /> ,,� , <br /> � �" `` ` ,� <br /> __., < _._. �.�� . , <br /> ,��` ���� ,��°`�°�����-,��`��:;� �`��" .�;�,�`��'--�`� �,.�- - s� -��,�� <br /> Vendor Mailing Address City State Zip . <br /> _. �. <br /> . � <br /> .���.��-_ � ��'�fw--���e� ��`�`�' ���'°� �� r�'2�=� �,�.�" :�-� ����`���� ° <br /> Phvne Emaii � <br /> ;, ;,.� ,_.-.�,:., ��b:�:.:�...:.w.::.:::: ���,..:...,.<:i;'.��a+�.iv�� t���ice�ba#e aheck directly for the <br /> instatlation at#he above referenced property address. By agreeing to recei�e the rebate check <br /> directly, t agree to the tollawing: <br /> 1. The Backwater Prevention Device rebate amountw;lt��..u.:�:::c: ;,�����+���+�o� �������� <br /> given ta the property o�vner fac the installation at the property address re�eerenced above, if <br /> the totai cost af the installation is greater than the�:bat�. <br /> 2. 1,the Vendor,am a Washington Stafe licensed contractar. <br /> 3. The City of Everett witl send� Federal Form 1099 MISC to m+�,the Vendor,for Backwater <br /> Prevention Dsvic:e rebat�:payments totalirig mor�tt�an�600 per calendar yea�, and will <br /> report the same payments to th� Intemal Revenue Ser�ice. <br /> E accept#he payment of the Backv+rater Preven#ion Device rebat�fram the City of Everett pending <br /> approval of#he compfeted Backwater Preverrtion Device rebate package by the City of Everett . <br /> �-�.� .,,� <br /> � �� '� ,. �����,�.� �--���~� <br /> —��� _ <br /> Signafure af Contra�tor Date <br />