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Contractor Section: <br /> clA <br /> eUel 115 I'Vkc-r17--tV/U • iere,-- tOt(4'vl 13( (1% La <br /> Vendor Name / Business Name/UBI Number <br /> er-p/u P <br /> State of Washington Contractor License Number: <br /> &361 WI-6,1/6w A cc, Plw tia:r t,„A- ? i- <br /> Vendor Mailing Address City State Zip <br /> 42-F— <br /> Phone 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, 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. <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 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 /> . if• <br /> Signature of Contractor Date <br />