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Jorgensen Registration 2017.tifCITY OF BLAIR 218S16TH STREET -7 2 04147 (D 0 F 4_ X 0 42• 195 E L. -ene : tyo lair@ i R. wal Form Jorgensen Contracting, Inc. 530 Front St Blair, NE 68008 PLEASE SUBMIT A COPY OF YOUR CURRENT NEBRASKA DEPARTMENT OF LABOR REGISTRATION Contractor Registration Report License Number: LCL201600001 License Issued To: License Type: Expires: Jorgensen Contracting Inc General Contractor License 12/31/2016 Certificate Issued To: Certificate Type: Expires: Jorgensen Contracting Inc Liability Certificate 01/01/2017 Issued by: &,Utk Brenda Wheeler, City Clerk YOUR CERTIFICATE OF LIABILITY i iwt-f 70vuemx?wt"', , 7-41 EXPIRE. PLEASE SUBMIT A NEW COPY WITH YOUR RENEWAL. 02/04/2017 09:36 4024268323 PAGE 01 Ammlyp 4f IIN ntii.l DF,PARTmKN'r (1P LAROR Nnb(alkt Ogwon onl of lAbor r—t.w(ot Rpgstrud m X54 So. Ibt1( Suw, LS(1c4)(1, NE MCA (402) 471- 22.19 Date las(+�d Ntc FxplfO T a 117 1/112619 jilCONTRACTOR 1BOT8'Z'RATiON MTIFICATE 114 orlii{GN1 ia.ryurunfvalk Fcc Fnjd' $40.00 RbgiMnd*gk N 23004 Year 17 �+►. N CjCJ99"' I#miness: Q JORGENSEN CONTPUCTING . ING, 31O FRONT ST -- W -,43P, NE 6500$ tvffirtbuu o.(1A60( 11 -CTIA