Monster Registration 2022FOR OFFICE USE ONLY C6
CO"I'TY OF BLAIR Date Paid:
218S. 16th Street Receipt No:
Date
Blair, NE 68008 BOND EXPIRES:
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.orgApplication is: New r-1 Renewal V
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 El Tree Trimmer- $60.00
Electrical Contractor - $60.00 El Drain Layer - $60.00
Gas Line Installer - $25.00 El Fire -Security system Installer -$25.00
El mechanical Contractor- $60.00 El Water Service Line Installer- $60.00
El Plumbing Contractor- $60.00
Business Name: M 0 c- A--�\c
Applicant Name: Ooi-\L AAi<
Business Address: S-0) 01 City: kcz' State: Zip:
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Mailing Address: '5 e -'M C City: State: Zip:
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Phone #: 4P �2L-A K�n
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Business Address outside of Nebraska:
City:. state Zip: Phone:
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Contact Person; nVA
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Number of Employees: 14 Apprentices: Journeymen: ft-e�L)Ak
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Other Licenses Held:
Insurance/Worker's Compensation Company:
General Contractors need to submit a Certificate of Insurance with minimum limits of $ 1,000,000 Aggregate/$ 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 Otclinances 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.
I
Authorized Signature" Date
3/31/22, 3:58 PM Official Nebraska Department of Labor - Contractor Registration - Contractor Details
Y' 1 s
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Contractor/Subcontractor Name
i
Monster Electric Inc.
Corporation Name
Business Entity
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S -Corporation
i
Address
5810 S. 92nd Cir
I
i
Omaha, NE 68127
City
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Omaha
t State
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NE
Zip
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68127
Telephone
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(402) 990-5356
1 Registration Number
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I
31699-21
Registration Expiration
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12/15/2022
I
t Sales Tax Option
C
k
2
Number of Employees
1
i
Worker's Compensation Status
Certificate on File (does not cover owners/corporate officials)
https://dol.nebraska.gov/conreg/Contractor/Details/3169921 1 /1