Laserfiche WebLink
Contractor Section; <br />Vendor Name / Business Name ! <br />Bi Number <br />Jcyb- � L- 1 l.t M S <br />State of Washington Contractor License Number: <br />Vendor Mailing Address <br />Phone <br />c <br />City State Zip <br />Email <br />I, the Vendor, agree to receive the Backwater Prevention Device rebate check directly for the <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />directly, 1 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 />2. 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 Internal 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 />Signature of Contractor Date <br />i' Y Ugram <br />�ogram <br />