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Contractor Section: <br /> pi. 13, t , ,,,,,,,q,,_ 7e -~ <br /> Vendor Name i Business Na e J UBI:Number <br /> 19-19-pl a 14X Ai/IP/#:3 <br /> State of Washington Contractor License Number: <br /> 6 if iftS*ht44C-4 ." ""ali toj. 9yzo8 <br /> Vendor Mailing AddressCity State Zip <br /> t,„ <br /> AzC.--- 4 81-041z3 trig-plumb' itc - 6,7)44-; <br /> Phone <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, 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 /> I,the Vendor,am a Washington State licensed contractor. <br /> 3. The City of Everett will send a Federal Form 1 099 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 packageby the City of Everett <br /> I., - -- t <br /> c as- <br /> • <br /> Signature . ¢ Tactor Date <br />