GA Registration 2021218S.16 th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: citypfblair@ci.blainnems
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES:
Application is: ❑ New X Renewal
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
C1
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 and Company, Inc.
Applicant Name: Gary West
Business Address: 1200 Radcliff Road
Email Address: megan.goff@gawest.com
Phone #: (251) 679-1965
Fax #: (251) 675-0366
Business Address outside of Nebraska:
City: Creola
State AL
Contact Person: Megan Goff
Number of Employees: 970
1200 Radcliff Road
City: Creola State: AL Zip: 36525
Mobile #:
Zip: 36525 Phone: (251) 679-1965
Apprentices: 125
Journeymen: 645
Other Licenses Held: AL, AR, FL, GA, KY, LA, MS, NC, ND, OH, SC, TN, 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. 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.
/,/ / 12/29/2020
Date
12/30/2020
Blair City Building Department
218 S. 16`h Street
Blair, NE 68008
Reference: 2020 Contractor Registration/ License Renewals
Dear Sir or Madam,
G.A. Nest and Company Inc., is not currently working in the State of Nebraska. Upon
further discussion with the Nebraska Department of Labor, we have been informed that
since G.A. `Vest and Company has no wages to report for the 4`h quarter of 2020 we will not
need to activate our account. G.A. West and Company does have an account number with
Nebraska's Department of labor.
The account number is 0387715003.
Should you have any questions or require additional information, please do not hesitate to
contact us at (251) 679-1965, or (251) 410-6266.
Megan Goff
` ,
�r
Executive Assistant
G.A. `Vest and Company Inc.