ABC Registration 2016.tifCITY OF BLAIR
218 S 16TH STREET
BLAIR, NE 68008
(402) 426 - 4191
FAX (402) 426 - 4195
Email: cityofbiair@ci.blair.ne.us
FOR OFFICE USE ONLY
:
Date Paid:
Receipt No: qqg—
Date Issued:
BOND EXPIRES•
CONTRACTOR REGISTRATION / LICENSE RENEWAL
ABC Seamless of Omaha
8032 Maple St
Omaha, NE 68134
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 391 4500 Fax 402 3914566"
Mobile 308 379 3369 LySg3
Email Address:
Type of Business:
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Franssen, Ted General Certificate of Liability 8/29/2015
Place a check in the box next to the licenses you wish to renew:
Renew Name License / Registration Expires
Franssen, Ted 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:
PLEASE SUBMIT A COPY OF YOUR I
LABOR , AT I ON
CERTIFICATEYOUR
INSURANCE IS
EXPIRE, PLEASE SUBMIT A NEW Copy
WITH
YOUR ,
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.
'Ph � lik
/ uth rized Signature Date
Ir Department of Labor
Labor Law / Contractor Registration
4WjNE'BRASKA 550 South 16th Street, 3rd Floor
DEPARTMENT OF LABOR Lincoln, NE 68508
��w�.ciol.r«�l�raslca.�w (402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor/Subcontractor Name: ABC SEAMLESS OF OMAHA
Address: 8032 Maple St
City: OMAHA
State: NE
Zip: 68134
Telephone: (402) 391 - 4500
Certificate Number: 26386
Certificate Expiration: 10/15/2016
Contractor Option: 2