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Infinity Registration 2018.tif
f • as 218S.16 1h Street Blair, NE 68008 (402) 426 4191 FAX: (402) 426 4195 Email: building@blairnebraska.org FOR OFFICE USE ONLY Date Paid: !_ l' Receipt No: Date Issued: BOND EXPIRES: Application is: ❑ New XRenewal CONTRACTOR REGISTRATION/LICENSE RENEWAL (Please type or print in ink — If you need more space, please attach additional sheets) Application is for:Contractor - $60.00 ElElectrical Contractor - $60.00 Water Service Line Installer- $60.00 ❑ Tree Trimmer- $60.00 E] 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: Infinity Roofing & Siding Inc Applicant Name: Niyv l T_WD Business Address: 18000 Groeschke Rd #G7 City: Houston State: TX Zip: 77084 Email Address: permits@infiniiyroofer.com Phone #: 888-855-2331 Fax #: 888-371-9080 Mobile #: Business Address outside of Nebraska: City: Contact Person: State Number of Employees: Apprentices: Other Licenses Held: Insurance/Worker's Compensation Company:, Zip: Phone: Journeymen: 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 with the certificate holder being the "City of Blair". All types of registrations must include proof of registration with the Nebraska Department of Labor. All information c tained in this application is true and correct. 1 will notify the City of Blair of any changes In the information reported on h this application form within 15 days of the change. 1 hereby4 application to the Licensi o r, Nebraska and certify that I am competent and experienced to engaged ve said vocation. 9�eeetto�conform ctly to the Ordinances of the City of Blair, Nebraska relative to said vocatio obey II order quirements and r ations of its lawful constituted authorities. This certification applies to the orlgina(i e se ar'or gistration and an ewals thereof. Authojized Signature Date https://dol. nebraska.gov/conreg/SearchContractors/ContractorDetails?regNum=25149 SEARCH REGISTERED CONTRACTORS & SUBCONTRACTORS Contractor/Subcontractor Name Infinity Roofing & Siding, Inc. Address 18000 Groeschke Rd. G7 City Houston State TX Zip 77084 Telephone 8888552331 Registration Number 37031 Certificate Expiration 06-01-2018 Contractor Option 2 Number of Employees 0 Back to Results © 2018 - NDOL Contractor Registration. For assistance call 402-471-2230 https:/Idol.nebraska.gov/conreg/SearchContractors/ContractorDetails?regNum=25149 1/2