City Registration 2011.tif i
FOR OFFICE USE ONLY
CITY OF BLAIR 67
218 S. 16TH STREET Date Paid:
BLAIR, NE 68008 Receipt No: 4 27 77 ?i
(402) 426 -4191 Date Issued: D "
' FAX (402) 426 -4195
BOND EXPIRES:
email: CityofBlair@huntel.net
.1 Promise o (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: City Wide Heating & A/C Sys. Inc.
i
Address
P. O. Box 308
Waterloo, NE 68069 -0308
Phone # 402 - 330 -3 120
Mobile # 402 289 4 822
Number of Employees: 10 Journeymen: 7 Apprentices: 2
Type of Business: Mechanical
Other Licenses Held: Omaha
Insured? No Worker's Compensation? No
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Bond Expires Amount
Brad Butcher Journeyman Heater / $25.00
9 Rick Lochmiller Residential Heater (Omaha 12/14/2010 $60.00
Paul Gargarella Journeyman Heater $25.00
List additional license /registrations:
Name License / Registration Bond Expires Amount
Please submit a copy of your
current City of Omaha License
l @ae submit a new pprimit bond with rneral.
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 vocation and obey all order, requirements and regulations of its lawful
constituted authorities.
Authorized Signature Date