Downs Registration 2011.tif I
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FOR OFFICE USE ONLY
- CITY OF BLAIR 227
218 S. 16TH STREET Date Paid: f ®/
BLAIR, NE 68008 Receipt No:
n (402) 426 -4191
Date Issued:
FAX (402) 426 -4195
email: CityofBlair@huntel.net BOND EXPIRES:
"I Promise 04
(Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
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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
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:
l�l I
Renew? Name License / Registration B s Amount
Dan Downs Electrical Contractor 11/14/2010 $60.00
Art Hazelton Journeyman Electrician $25.00
Ryan Hall Journeyman Electrician $25.00
Al Arett Journeyman Electrician $25.00
Steve Suden Journeyman Electrician $25.00
Dan L. Downs General Contractor 05/16/2011 $60.00
List additional license /registrations:
Name License / Registration Bond Expires Amount
leave submit a new Permit bond are eo y o
tat@ lectrica! r ( .q) with renewal.
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.
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 yqcati and obey al rder, r irements and regulations of its lawful
constituted authorities.
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Authorized Signatur Date