Cooling Registration 2010.tif I
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- CITY OF BLAIR 1402 FOR OFFICE USE ONLY 1 C
218 S. 16TH STREET Date Paid: _/ 4 - 1-1p /V t�,
' BLAIR, NE 68008 Receipt No:
(402) 426 -4191
x a Date Issued: �®
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FAX (402) 42
�� 6 -4195
i^ O BOND EXPIRES:
email: CityofBlair@huntel.net
� promise ° (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: Cooling Tower Depot, Inc.
Address Bill Howard P.E. 720 - 746 -1234
651 Corporate Circle Certificate Received
Suite 206
Golden, CO 80401
Phone # 720 - 746 -1 234
Mobile # 303 241 6 369
Number of Employees: 12 Journeymen: 4 Apprentices: 8
Type of Business: General Contractor
Other Licenses Held:
Insured? Yes Worker's Compensation? Yes
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Place a check in the box next to the licenses you wish to renew.
Renew? Name License / Registration Certificate of Liabili Expires Amount
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[ Bill Howard P.E. General Contractor 4/1/2010 ' f $60.00,,, /
List additional license /registrations:
Name License / Registration Bond Expires Amount
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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.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and j
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.
Autbotiz ignature Date