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3 <br /> 111 <br /> l <br /> S <br /> 9 <br /> i <br /> 1 <br /> 1 <br /> g <br /> :5 <br /> Contractor Section: <br /> , <br /> 3 <br /> 6oz._ 7oP73 <br /> I <br /> endor Name/Business Name/UBI Number i <br /> 16/'l f Ohl/a6 _ <br /> State of Washington Contractor License Number_ i. <br /> P6 0,S1j .e (/- <br /> Vendor Mailing Address <br /> City .State Zip <br /> p1-19--4,at1/0fvzy L9-47� Cavia f.e i <br /> Phone Email �I <br /> r <br /> I <br /> 1 <br /> w <br /> 1,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 /> 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. i <br /> i <br /> 2. I,the Vendor,am a Washington State licensed contractor. i <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me,the Vendor,for Backwater 1 <br /> Prevention Device rebate payments totaling more than$600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. 1 <br /> i <br /> I <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 i <br /> w <br /> 8 <br /> iier <br /> --‹; - . . ' Aelf/;2-,- 2--eVi <br /> Signature of Contractor .. Date <br /> I <br /> 2 <br />