QualityF Registration 2010.tif i
FOR OFFICE USE ONLY
CITY OF BLAIR 285
218 S. 16TH STREET Date Paid: % – 11 ° J-9/ Q (�
BLAIR, NE 68008 Receipt No:
' (402) 426 -4191
Date Issued:
FAX (402) 426 -4195
email: CityofBlair@huntel.net BOND EXPIRES:
promise o (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information; �
Business Name: Quality Fence
Address n � " -f eieeL -94
17716 Storage Rd.
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Omaha, NE 68136
Phone # 402 896 9 325
Mobile #
Number of Employees: Journeymen: 0 Apprentices: 0
Type of Business: Fence Installer
Other Licenses Held: Nebraska, LaVista, Elkhorn
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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
General Contractor 6/3/2010 $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 cation and obey all order, requirements and regulations of its lawful
constituted authorities.
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t o i d Si a Date