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Contractor Section: <br /> 47) Q -"Pi )yt -), f )/:; ' (-21 ( 5 , <br /> Vendor Name/Business Name/ UBI Number <br /> State of Washington Contractor License Number: <br /> ,�u j <br /> Vendor Mailing Address City State Zip <br /> t ). l <br /> Phone Email <br /> A <br /> iii <br /> ,,,,, ', , <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 /> i <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 /> F 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 /> � �� € � <br /> 3i <br /> I accept the payment of the BackwaterPrevention Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the City of Everett <br /> / <br /> t <br /> , ir <br /> Signature of Contrac r Date <br /> !' r <br /> _.ma 4rikr; flax <br /> a k,. ....:'.� S�.... xe,,,,, x. may,. „ .. Y`g _ .. ,» �€' � .� .�` . <br />