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Contractor Section: <br /> 98 ?-' <br /> Vendor Name/Business Name/UBI Number <br /> oK'T14- J C ?O ?� <br /> State of Washington Contractor License Number: <br /> 6 EGY\ 1 Z. 1 <br /> Vendor Mailing Address City State Zip <br /> I{2�= T/ AittiVeiteC ,tom, <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 /> tY <br /> r 3,1+- 05/?-01-7 <br /> Signature of Contractor Date <br />