Luxa Registration 2010.tif i
FOR OFFICE USE ONLY
CITY OF BLAIR 22
218 S. 16TH STREET Date Paid:
BLAIR, NE 68008 Receipt No
(402) 426 -4191 p�
�-,- �.Jf 0
FAX (402) 426 -4195 Date Issued.
ate Q o ° email: CityofBlair@huntel.net BOND EXPIRES:
q Promise ° (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
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Business Name: Luxa Construction Company, Inc.
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Address Mike Luxa
925 East Dixon Road
P.O. Box 105
Blair, NE 68008
Phone # 402 - 426 -2 778
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Mobile # 402 510 82 00
Number of Employees: 60 Journeymen: 0 Apprentices: 0
Type of Business: General Contractor
Other Licenses Held:
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
r Mike Luxa General Contractor 8/1/2010 $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.
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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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Authorize - ignature Date