APX Registration 2010.tif FOR OFFICE USE ONLY
CITY OF BLAIR 1404
218 S. 16TH STREET Date Paid: I q `
BLAIR, NE 68008 Receipt No:
�L (402) 426 -4191
te n; Date Issued:
FAX (402) 426 -4195
email: CityofBlair@huntel.net BOND EXPIRES:
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promise (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: APX Alarm Security Solutions, Inc.
Address Larry Stephen Evers Sheralyn Bennett
..54-32 N 300 W
Provo, UT 84604
Phone # 800 - 216 -5 232
Mobile # 801 - 705 -8 075
Number of Employees: 5 Journeymen: Apprentices:
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Type of Business:
Other Licenses Held:
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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 Bond Expires Amount
❑ Larry S. Evers Fire /Security System Installer $25.00
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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Authorized Signature Date