ABC Registration 2010.tif FOR OFFICE USE ONLY
v, CITY OF BLAIR 1005
218 S. 16TH STREET Date Paid
BLAIR, NE 68008 Receipt No. '
(402) 426 -4191
Date Issued: " t Q
FAX (402) 426 -4195
BOND EXPIRES:
y o° email: CityofBlair @huntel.net
..1 Promise ° (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: ABC Seamless of Omaha
Address
2705 N 85th St Certificate Received
Omaha NE 68134
Phone # 402 391 4 500
Mobile # 308 379 3 369
Number of Employees: 8 Journeymen: Apprentices:
Type of Business: ,_..> 4L � �� ,ire
Other Licenses Held: LaVista
Insured? Yes Worker's Compensation? Yes
Place a check in the box next to the licenses you wish to renew.
Renew? Name License / Registration Certificate of Liability Expires Amount
❑ Ted Franssen General Contractor 8/29/2009 ' $60.00
List additional license / registrations:
Name License / Registration Bond Expires Amount
YOUR CERTIFICATE OF LIABILTI"Y
INSURANCE IS EXPIRED OR ABOUT
t£`
TO EXPIRE. PLEASE T A NEW °
COPY WITH YOUR RENEWAL' , C�
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.
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Authorized Signature Date