Jorgensen Registration 2020CITY OF BLAIR
218S16 TH STREET
PLEASE SUBMIT 14 COPY (",$
YOUR 2020 NEBRASKA
DEPARTMENT OF LABOR
RE GISTRATION
BLAIR, NE 68008
(402) 426-4191 2020 Renewal Form
FAX (402) 426-4195
EMAIL: building@BlairNebraska.org
Jorgensen Contracting Inc 1
530 Front St
Blair, NE 68008
YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED OR ABOUT TO i
EXPIRE. PLEASE SUBMIT A NEW COPY WITH
YOUR RENEWAL.
d
Contractor Registration Report
License Number: LCL201600001
License Issued To:
Jorgensen Contracting Inc
Certificate Issued To:
License Type: Expires:
General Contractor License 12/31/2019
Certificate Type: Expires:
Jorgensen Contracting Inc Liability Certificate 01/01/24HY9"
Issued by: &Wt�, �)w4c
Brenda Wheeler, City Clerk
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