Wiig Registration 2021MWr
218 S. 1611 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:
Application is: ❑ New ❑ 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 ❑ Tree Trimmer- $60.00
Electrical Contractor- $60.00 ❑ Drain Layer- $60.00
❑ Gas Line Installer - $25.00 ❑ Fire -Security System Installer -$25.00
❑ Mechanical Contractor -$60.00 ❑ Water Service Line Installer- $60.00
iI ❑ Plumbing Crrontractor- $60.00
Business Name: t�) r 1 S L ip C7U i Cu
Applicant Name: �u S S i C
Business Address: vcj Ile Ci City: )-&%1 4 - — State:f Zip: 12
Mailing Address: 1�?D zy fo 1,0 r;� f City: 41 State: Zip:4�9�
Email Address: -W i i l rr` �f 1,C
Phone #:'�-� �r Fax #: Mobile #: 114 2
Business Address outside of Nebraska:
City: State Zip: Phone:
Contact Person: LA -9 i C
Number of Employees: _ Apprentices: Journeymen:
Other Licenses Heid: _-
insurance/Worker's Compensation Company: �i:�U w",
Electrical, Gas Lline Installer, Mechanical, Plumbing Contractors and Tree Trimme'r's heed a $5,000 permit bond stating'`Jahn
dba Company Name" In favor of the City of Blair. Electrical Contractor and Fire Security Systems Installer wlil need to submit e
,copy of your Nebraska State License.
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,00OAggregate/$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 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. 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.
orized Signature Date
218 S. 16th 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:
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for: Journeymen/Apprentice - $25.00 each
Business Name: / A ) I i
Master's
Business Address: /Y .Sa y�y� r city:LiL,4 .. State: Zip:z I—Z-P
Phone # _7'l/_ L�% Mobile #: j�O Z6 -
Please List all employees that you wish to register and check the appropriate boxes.
Name Plumber
Heater
Electrician
Apprentice
Journeyman
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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.
1 hereby make application to the Licensing Board of Blair, Nebraska and certify that 1 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.
4u�thorjzecl ignature Date _
9/2/2021
Official Nebraska Department of Labor - Contractor Registration - Contractor Details
Contractor Details
Contractor/Subcontractor Name
Corporation Name
Business Entity
Address
City
State
Zip
Telephone
Registration Number
Registration Expiration
Sales Tax Option
Number of Employees
Worker's Compensation Status
WIIG ELECTRICAL SERVICES, INC.
WIIG ELECTRICAL SERVICES, INC.
Corporation
8014 S 92 AVE CIR
LAVISTA, NE 68128
LAVISTA
NE
68128
(402) 537-8142
25840-20
10/15/2021
2
1
Certificate on File
https://dol.nebraska.gov/conreg/Contractor/Details/2584020 1/1