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Contractor Section <br /> Vendor Name!`Business Name/1.313I Number <br /> A-0-pit/ 1.-Ptiel**) <br /> State of Washington Contractor License Number: <br /> J:)611 I 31 a VIL 11W (41 <br /> Vendor Mailing Address City St to Zip <br /> AtCc2.1 d <br /> . + ` 6,77,9,(„6,1,._ <br /> Phone Emelt <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 /> 111141 <br /> Signat .c- of Contractor Date <br />