TotalC 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: d le-"
Receipt No: Yl 75�CJLJJ
Date Issued:
BOND EXPIRES,
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Total Construction Services, Inc.
6727 N. 56th St
Omaha, NE 68152
Phone numbers on record:
Type: Phone Number:
Office 402 572 7457
Mobile 402 306 0340
Email Address:
Type of Business:
Type: Phone Number:
Please verify and correct
the company/business
information listed here:
} YOUR
DEPARTMENT 01'
LABOR
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires ' I
Jackson, Kevin
General Certificate of Liability
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration
Jackson, Kevin General Contractor
Please list any additional license or registrations:
Name License / Registration
3/14291,6—eo I,
Expires Amount
12/31/2015 $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, riquirements and regulations of its lawful constituted authorities.
Authori nature Date
S"G�
4WINEBRASKA
DEPARTMENT OF LABOR
www.dol.nebras.ka.gov
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: TOTAL CONSTRUCTION SERVICE
Address: 6727 NORTH 56TH STREET
City: OMAHA
State: NE
Zip: 68152
Telephone: (402) 572 - 7457
Certificate Number: 22188
Certificate Expiration: 11/01/2016
Contractor Option: 2