Eyman Registration 2021'Olmse 01 op,
EYMAN PLUMBING
8506 S 117TH ST
LAVISTA NE 68128
Type of Business:
CITY OF BLAIR
218 S 16"' Street
Blair, NE 68008
(402) 426-4191
Fax (402) 426-4195
Email: buildhig@blairnebraska.org
CONTRACTOR REGISTRATION REPORT
March 18, 2020
Issued by• 6" k 1A)hJ-vc
Brenda 'Wheeler, City Clerk
CITY OF BLAIR
218 S. 16th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: cityofblair@ci.blainne.us
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES:
Application is: ❑ New KRenewal
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 ❑ 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- $60.00Plumbing Contractor- $60.00
❑ Drain Layer- $60.00
Business Name: _ r— V ma- Kt
Applicant Name: ` 1 D rr\ 1_
Business Address: 1'56 G 'r, 5j- City: LA Vt 5I -A State: W-7 Zip:
Email Address: 2 Lt -S -r A- nJ . e ° 07
Phone #: //OP - ?3/-2919 Fax #:
Business Address outside of Nebraska:
City:
Contact Person:
Number of Employees:
Other Licenses Held:
State
Apprentices:
Zip:
Mobile #:
Phone:
Journeymen:
Insurance/Worker's Compensation Company: 4 ¢} 1.0 o G
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. I 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, requirements and regulations of its lawful constituted authorities. This certification applies to the
original license and/or registration and any renewals thereof.
Authorized Signature I Date
3/18/2021 Official Nebraska Department of Labor - Contractor Registration - Contractor Details
Contractor Details
Contractor/Subcontractor Name
EYMAN PLUMBING, INC.
Corporation Name
EYMAN PLUMBING, INC.
Business Entity
Corporation
8506 S. 117TH STREET
Address
LAVISTA, NE 68128
City
LA%7ISTA
State
NE
Zip
......._ ..... _. _. _.... .
68128
Telephone
(402) 731-2727
Registration Number 21387-20
Registration Expiration 9/15/2021
Sales Tax Option 1
Number of Employees 113
Worker's Compensation Status Certificate on File
https://dol.nebraska.gov/conreg/Contractor/Details/2138720 1 /1