PrairieC Registration 2016.tifCITY 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: q(�Ci�
Date Issued:
BOND EXPIRES -
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Prairie Construction Company
13316 B St
Omaha, NE 68144
Phone numbers on record:
Type: Phone Number:
Office
Fax
Email Address:
402 330 852.2
402 330 8544
Type of Business: GENERAL
DEC 17 2015
Type: Phone Number:
Please verify and correct
the company/business
information listed here.
PLEASE SUBMIT A COPY OF YOUR
CURRENT NEBRASKA DEPARTMENT OF,
LABOR REGISTRATION
Please submit new certificates or bond renewals for those which have expired.
Name Certificate of Liability or Bond Expires
Prairie Construction Co General Certificate of Liability 1/1/2016
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires
Prairie Construction Co General Contractor 12/31/2015
Please list any additional license or registrations:
Name License / Registration
N
YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED OR ABOUT TO
EXPIRE. PLEASE SUBMIT A NEW COPY,`
WITH YOUR RENEWAL.
Amount
$60
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.
Ll
Authorized Signature Date
Department of Labor
N E B R A S K A Labor Law / Contractor Registration
550 South 16th Street, 3rd Floor
DEPARTMENT OF LABOR, Lincoln, NE 68508
www.doi.nebraska.,;ov (402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor/Subcontractor Name: PRAIRIE CONSTRUCTION COMPANY
Address:
City:
State:
Zip:
Telephone:
Certificate Number:
Certificate Expiration:
Contractor Option:
13316 B STREET
OMAHA
NE
68144-3612
(402) 330 - 8522
21811
10/01/2016
2