Natureworks Registration 2016.tifNatureWorks LLC
650 Industrial Park Dr
Blair, NE 68008
CITY OF BLAIR
218 S 16TH STREET
BLAIR, NE 68008
(402) 426 - 4191
FAX (402) 426 - 4195
Email: cityofblair@ci.blair.ne.us
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES'
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Phone numbers on record:
Type: Phone Number:
Office 402 237 3841
Office 402 306 6984
Email Address:
Type of Business:
Type:
Fax
Please verify and correct
the company/business
information listed here:
Phone Number:
402 237 3801
PLEASE SUBMIT A COPY OF YOUR
CURRENT NEBRASKA DEPARTMENT OF
LABOR REGISTRATION
Please submit new certificates or bond renewals or those which have expire_ f p YOUR CERTIFICATE OF LIABILITY
Name Certificate of Liability or Bond Expires INSURANCE IS EXPIRED OR ABOUT TO
Sheehan, John General Certificate of Liability 12/1/2015 EXPIRE. PLEASE SUBMIT ANEW COPY
Place a check in the box next to the licenses you wish to renew: WITH YOUR RENEWAL.
Renew? Name License / Registration Expires Amount
Sheehan, John General Contractor 12/31/2015 $60
Please list any additional license or registrations:
Name License / Registration
Amount
All information contained in this application is true and correct. I will notify the City of Blair of any changes in the
information reported on or with this application form within 15 days of change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and obey all order, requirements and regulations of its lawful constituted authorities.
orized Signature Date
4WPA
NEBRASKA
DEPARTMENT OF LABOR
Department of Labor
Labor Law / Contractor Registration
550 South 16th Street, 3rd Floor
Lincoln, NE 68508
(402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor/Subcontractor Name:
Address:
City:
State:
Zip:
Telephone:
Certificate Number:
Certificate Expiration:
Contractor Option:
NatureWorks LLC
P.O. Box 564
Blair
NE
68008
(402) 237 - 3841
44473
10/01/2016
2