OmahaD Registration 2022._,Omise of CP -
CITY OF BLAIR
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 Issues:
BOND EXPIRES:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct the
OMAHA DOOR & WINDOW CO INC company /bnsiness
4665 G ST Information listed here:
OMAHA NE 68117
Type of Business: CONTRACTOR LICENSE
Contact information on record: T
Type: Phone Number:
Works 402 733-6440 Fax
Cell 402 590-2847
Please submit a current reci rocatin license and NDOL or those which have expire
Reciprocating License:
Name:
OMAHA DOOR & WINDOW CO NDOL
Please submit new certi rcates or bond renewals for those which have expired:
Name: Certificate of Liability or Bond:
OMAHA DOOR & WINDOW CO IGENERAL
Place a check in the box next to the licenses
Renew? Name:
0 OMAHA DOOR & WINDOW CO INC
El
wish to renew:
License / Registration: Expires
CONTRACTOR LICENSE 1/01/2022
9/15492+
2/01 /2022
0
Please list any.additional licenses or stratons
Name:
/ Re istrration: Amount:
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and
experienced to engage in the above said vocation.
I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey all
orders, requirements and regulations of its lawful constituted authorities.
I also certify that 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 any change.
Authorized Signature Date
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
OMAHA DOOR & WINDOW COMPANY, INC.
OMAHA DOOR & WINDOW COMPANY, INC.
Corporation
4665 G STREET
OMAHA, NE 68117-1489
OMAHA
NE
68117-1489
(402) 590-2847
21334-21
9/15/2022
3
97
Certificate on File