QualityF Registration 2023CITY OF BLAIR
218 S. 161" 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:
Application is: New
Renewal
C
0_
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 WaG Service Line Installer - $60.00
❑ Plumbing Contractor - $60.00
Business Name: l J I ` I I '/- V d, M f4j, L,
Applicant Name:
Business Address:
Mailing Address:
Email Address:
Phone #:
Business Address outside of Nebraska:
City:
Contact Person:
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Number of Employees: Apprentices:
Other Licenses Held:
InsuranceMorker's Compensation Company:
Zip: Phone:
Journeymen:
Electrical, Gas Line Installer, Mechanical, Plumbing Contractors and Tree Trimmers need a $5,000 permit bond stating "John Doe
dba Company Name" 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 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,
3/14/23, 11:49 AM Official Nebraska Department of Labor - Contractor Registration - Contractor Details
Contractor Details
Contractor/Subcontractor Name Quality Fence LLC
Corporation Name
Business Entity
Address
i
City
State
Zip
i
Telephone
i
Registration Number
f
Registration Expiration
Sales Tax Option
Number of Employees
Worker's Compensation Status
Quality Fence LLC
S-Corporation
401 N Jackson St
Papillion, NE 68046
Papillion
NE
68046
(402)896-9325
46591-22
11/1/2023
2
8
Certificate on File
https://dol.nebraska.gov/conreg/Contractor/Details/4659122 1/1