USM Registration 2012.tif CITY OF BLAIR FOR OFFICE USE ONLY
f ' 218 S 16TH STREET
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BLAIR, NE 68008 Date Paid: l -mfg
(402) 426 - 4191 Receipt No:
FAX (402) 426 - 4195 Date Issued:
Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWA
Please verify and correct
the company /business
US Mechanical Service Inc. information listed here:
1209 Royal Dr
PAPILLION, NE 68046
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Phone numbers on record:
Ty pe: Phone Number: Type: Phone Number:
Office 402 -991 -2899
Mobile 402 - 657 -6600
Email Address:
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Type of Business: MECHAN
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Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Craig Labs Mechanical Bond 3/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Craig Labs Mechanical Contractor 12/31/2011 $60
' Mike Sorensen � Apprentice Mechanical 12/31/2011 $25 �
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.
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.
A orized Signature Date
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