USM Registration 2019.tif°4se of a�
CITY OF BLAIR
218S16 TH STREET
BLAIR, NE 68008
(402) 426-4191 2019 Renewal Form
FAX (402) 426-4195
EMAIL: building@BlairNebraska.org
US Mechanical Service Inc.
1209 Royal Dr
Papillion, NE 68046
April 24, 2018
Contractor Registration Report
License Number: LCL201100036
License Issued To: License Type: Expires:
Fiscus, Ben
Rollings, Taylor
Nissen, John
Totusek, Andrew
Labs, Craig
Bond Issued To:
Labs, Craig
Mechanical Contractor Apprentice License
12/31/2018
Mechanical Contractor Journeyman License
12/31/2018
Mechanical Contractor Journeyman License
12/31/2018
Mechanical Contractor Journeyman License
12/31/2018
Mechanical Contractor Master License
12/31/2018
Bond Type: Expires:
Mechanical Bond 03/01/2019
Issued by:
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Brenda Wheeler, City Cleric
218 S. 161h Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES:
CHA Ni GEIA DDI TIONS FORM
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink - If you need more space, please attach additional sheets)
Application is for
Business Name:
Master Plumber/Heater/Electrician - $60.00 each
Journeymen/Apprentice - $25.00 each
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E -Mail Address:_` (2, 0
Phone #:`Mobife #:
Please List all employees that you wish to register and check the appropriate boxes.
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. 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. This certification applies to the
original license and/or registration and any renewals thereof.
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Au oriz d Signature X Date
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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. 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. This certification applies to the
original license and/or registration and any renewals thereof.
v 'IL_�
Au oriz d Signature X Date
1/16/2019 Official Nebraska Department of Labor- Contractor Registration - Contractor Details
Contractor Details
Contractor/Subcontractor Name
U.S. Mechanical Service Inc.
Corporation Name
Address
1209 Royal Dr.
Papillion, NE 68046
City
Papillion
State
NE
Zip
68046
Telephone
(402) 991-2899
Registration Number
38033-18
Certificate Expiration
10/15/2019
Contractor Option
1
Number of Employees 7
Worker's Compensation Status Certificate on File
https://dol.nebraska.gov/conreg/Contractor/Details/3803318 1/1