Takoda Registration 2016.tifTakoda Green Inc
2905 N 59th St
OMAHA, NE 68104
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: 1
Date Issued:
BOND EXPIRES -
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Phone numbers on record:
Type: Phone Number:
Office
Fax
Email Address:
402 938 3335
402 885 8295
Type of Business:
Type: Phone Number:
Mobile 402 306 1965
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Starkey, Jason General Certificate of Liability 10/16/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires
Starkey, Jason General Contractor 12/31/2015
Please list any additional license or registrations:
Name License / Registration
Please verify and correct
the company/business
information listed here:
YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED OR ABOUT TOI`
EXPIRE. PLEASE SUBMIT A NEW COPY V/1
WITH YOUR RENEWAL.
PLEASE SUBMIT A COPY OF
1-113OR REGISTRATION
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.
f.
Authorized SiahatureDat
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: Takoda Green Inc.
Address: 6701 Emmet Street
City: Omaha
State: NE
Zip: 68104
Telephone: (402) 978 - 3335
Certificate Number: 41330
Certificate Expiration: 06/01/2016
Contractor Option: 2