ABC Registration 2011.tif I
FOR OFFICE USE ONLY
CITY OF BLAIR 1005 0
218 S. 16TH STREET Date Paid: V ®l s d
�? BLAIR, NE 68008
Receipt No: � �]
(402) 426 -4191
FAX (402) 426 -4195 Date Issued:
.3 BOND CityofBlair @huntel.net EXPIRES:
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promise °
(Continued)
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CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: ABC Seamless of Omaha
Address /}
� n rr°°i v� th c t li' Z
ovvv� 6L( MU
Omaha, NE 68134
Phone # 402 3914 500
Mobile # 308 379 3 369
Number of Employees: 8 Journeymen: Apprentices:
Type of Business:
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 �j�,e�s Amount
❑ Ted Franssen General Contractor 08/29/2010 $60.00
List additional license / registrations:
Name License / Registration Amount
- YOUR CERTIFICATE OF LIABILITY
1 1NSURAINJC a5 EI'v.PU:ED 0::A;I0 UT j
TO EXPIRE. PLEASE SUBMIT A NEW
COPY WITH YOUR RENEWAL
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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 s ' and obey all order, requirements and regulations of its lawful
constituted authorities.
Authorized Signature Date
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