OmahaD Registration 2011.tif I
FOR OFFICE USE ONLY / _ 0
CITY OF BLAIR 185 (A
218 S. 16TH STREET Date Paid:
BLAIR, NE 68008 Receipt No: c[ 7 73
(402) 426 -4191 Date Issued: - �0
FAX (402) 426 -4195
�0�• � �� �
a o ° email: CityofBlair@huntel.net BOND EXPIRES:
� promise 0 (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: Omaha Door & Window Co., Inc.
Address
4665 °G Street j
Omaha, NE 68117
Phone # 402 - 733 -6 440
Mobile #
Number of Employees: i'1 Journeymen: Apprentices:
Type of Business: General Contractor
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Other Licenses Held:
Insured? Yes Worker's Compensation? Yes
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Place a check in the box next to the licenses you wish to renew:
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Renew? Name License / Registration Amount
General Contractor 04/01/2011 $60.00
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List additional license / registrations:
Name License / Registration 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.
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 ` ey all order, requirements and regulations of its lawful
constituted authorities.
Authorized Signature Date