Downs Registration 2012.tif i
CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68008 Date Paid: I
sr -. (402) 426 - 4191 Receipt No:.
FAX (402) 426 - 4195 Date Issued: —
Use i Email: cityofblair @ci.blair.ne.us BOND E XPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business j
Downs Electric, Inc. information listed here:
1808 Madison St
Omaha, NE 68107
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402.- 733 -3080
Mobile
Email Address: _
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Type of Business: ELECTRICAL
Please submit new reciprocating license for those which have expired:
Name Reciprocating License Expires
Arett, AI Electrical State Card 12/31/2012
Hazelton, Art Electrical State Card 12/31/2012
Downs, Dan L. Electrical State Card 12/31/2012
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Hall, Ryan Electrical State Card 12/31/2012
Suden, Steve Electrical State Card 12/31/2012
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Dan Downs Electrical Bond 11/14/2012
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Dan L. Downs General Certificate of Liability 5/16/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
AI Arett Journeyman Electrical 12/31/2011 $25
Dan Downs Electrical Contractor 12/31/2011 $60
Dan L. Downs General Contractor 12/31/2011 $60
Ryan Hall Journeyman Electrical 12/31/2011 $25
4 Art Hazelton Journeyman Electrical 12/31/2011 $25
--Steve Suden Journeyman Electrical 12/31/2011 $25
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Please list any additional license or 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 change.
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I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
enga a in above said vocation. I e to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
voc 'on d obey I o er, re uire ents and regulations of its lawful constituted authorities.
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Authorized Sikhature Date
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