QualityF Registration 2011.tif i
FOR OFFICE USE ONLY
CITY OF BLAIR
21 8 Date Paid: ✓�5� l � D
` BLAIR NE 68008
Receipt No:
` ,
(402) 426 -4191 Date Issued: � � q
FAX (402) 426 -4195
email: CityofBlair@huntel.net BOND EXPIRES:
q promise o� (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
Business Name: Quality Fence
Address Denny Brown
17716 Storage Rd.
Omaha, NE 68136
Phone # 402 896 9 325
i
Mobile #
Number of Employees: 23 Journeymen: 0 Apprentices: 0
Type of Business: Fence Installer
Other Licenses Held: Nebraska, LaVista, Elkhorn
Insured? Yes Worker's Compensation? Yes
Place a check in the box next to the licenses you wish to renew:
Ren ew? Name License / Registration ,(40 Amount
General Contractor 06/03/2011 $60.00
List additional license /registrations:
Name License / Registration Amount
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.
Aut4ize na tu Date