Downs Registration 2010.tif I
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FOR OFFICE USE ONLY
CITY OF BLAIR
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218 S. 16TH STREET Date Paid: t o ++ U D
BLAIR, NE 68008 Receipt No:
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(402) 426 -4191
FAX (402) 426 -4195 Date Issued:
email: CityofBlair@huntel.net BOND EXPIRES: / C1
9 promise (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: Downs Electric, Inc.
Address Dan L. Downs
1808 Madison Street
Omaha, NE 68107
Phone # 402 - 733 -3 080
Mobile #
Number of Employees: 7 Journeymen: 7 Apprentices: 2 j
Type of Business: Electrical
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 Bond Expires Amount
❑ Dan Downs Electrical Contractor m . 11114/2010 $60.00
❑ Art Hazelton Journeyman Electrician as $25.00
❑ Ryan Hall Journeyman Electrician $25.00
❑ Al Arett Journeyman Electrician $25.00
❑ Steve Suden Journeyman Electrician $25.00
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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.
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.
Au prized Signature Da
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FOR OFFICE USE ONLY
Date Paid: _�_ ®`
218 S. 1 G Street Receipt No:
Date Issued: 441.0
Blair, NE 68008 BOND EXPIRES:
(402) 426 4191 FAX: (402) 426 4195
Email: cit ofblair@ci.blainne.us
Y Application is: ® New El New I
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CON TRACTOR I T TI /LI E RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for: Contractor - $60.00 ❑ Electrical Contractor - $60.00
❑ Water Service Line Installer- $60.00 ❑ Tree Trimmer - $60.00
❑ Fire /Security System Installer - $25.00 ❑ Gas Line Installer- $25.00
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Mechanical Contractor- $60.00 E Plumbing Contractor - $60.00
❑ Drain Layer - $60.00
Business Name: Downs Electric, Inc.
Applicant Name: Dan L. Downs
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Business Address: 1808 Madison Street City; Omaha State: NE Zip: 6810 j
Phone #: 402 - 733 -3080 Fax #: 402 - 733 -3800 Mobile #: 402 -510 -2727
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Business Address outside of Nebraska: N/A
City: State Zip: Phone:
Contact Person: Dan Downs
Number of Employees: 12 Apprentices: 4 Journeymen: 7
Other Licenses Held: City of Omaha• State of Nebrashn; City of R1 a; r
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Insurance/ Worker "S Compensation Company: Cincinnati Insurance Company
Drain Layers /Electrical, Plumbing and Mechanical Contractors/Water Service Line Installers need a $5,000 permit bond in favor
of the City of Blair. Tree Trimmers need a $5,000 permit bond in favor of the City of Blair. Electrical Contractor and Fire
Security Systems Installer will need to submit a copy of your Nebraska State License.
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,000 Aggregate /$300,000 each
o ccurrenc e.
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.
1 hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in above said vocation. 1 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. This certification applies to the
original license and /or registration and any renewals thereof.
r 3/31/10
uthorize Signature Date
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