GA Registration 2018.tifCITY OF BLAIR
218S.16 th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: cityofblair@ci.blair.ne.us
FOR OFFICE USE ONLY
Date Paid:g
Receipt No: t I + r'--
Date Issued:
BOND EXPIRES:
Application is: n New ❑ Renewal
CONTRACTOR REGISTRATiON/LICENSE RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for: FKI Contractor - $60.00 ❑ Electrical Contractor - $60.00
❑ Water Service Line Installer- $60.00 ❑ Tree Trimmer- $60.00
❑ Fire/Security System installer - $25.00 ❑ Gas Line Installer - $25.00
❑ Mechanical Contractor- $60.00 ❑ Plumbing Contractor- $60.00
❑ Drain Layer- $60.00
Business Name: G.A. West & Company, Inc.
Applicant Name: Gary A. West
Business Address: 1200 Radcliff Road City: Creola State: AL Zip: 36525
Email Address: april.klein(cr�gawest.com
Phone #: (251) 679-1965 Fax #: (251)675-0366 Mobile #:
Ji&"(. `jyf -- 39 oY, (.r; o-.^,
Business Address outside of Nebraska: 1200 Radcliff Road
City: Creola State AL Zip: 36525 Phone: _(251) 679-1965
Contact Person: April Klein
Number of Employees: 987 Apprentices: 227 Journeymen: 566
Other Licenses Held: AL AR FL GA KY LA MS, NC, ND, OH, OK, SC, TM TX, VA
Insurance/Worker's Compensation Company: Cobbs Allen
Drain Layers/Electrical, Plumbing and Mechanical Contractors/Water Service Line Installers need a $5,000 permit bond In favor
of the City of Blair. Tree Trimmers need a $5,000 permit bond in favor of the City of Blair. Electrical Contractor and Fire
Security Systems Installer will need to submit a copy of your Nebraska State License.
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,000 Aggregate/$300,000 each
occurrence.
All Information contained in this application is true and correct. 1 will notify the City of Blair of any changes in the information
reported on or with this application form within 15 days of the 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. 1 agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and obey all order, requiremenqand regulations of its lawful constituted authorities. This certification applies to the
original lic pse and/or registration and a�y renewals thereof.
Ail — . I o / 1/
Date
NEDRAS KA
DEPARTMENT OF LABOR
Nebraska Department of Labor -
Contractor Registration
550 So. 16th Street, Lincoln, NE 68508
(402) 471 - 2239
Date Issued
2/15/2018
CONTRACTOR REGISTRATION CERTIFICATE
This certificate is non -transferable
Fee Paid: $40.00 Registration #
51358
Year
Business:
G.A. West and Company, Inc.
1200 Radcliff Road -- Creola, AL 36525
Date Expires
2/15/2019
Conunissioner of Labor