OmahaD Registration 2012.tif i
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CITY OF BLAI $ FOR OFFICE USE ONLY
218 S 16TH STREET!i
I BLAIR, NE 68008 Date Paid: �f
Receipt t No: 49
(402) 426 - 4191 p
FAX (402) 426 - 4195 Date Issued: BOND EXPIRES
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e� Email: cityofbiair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEW
Please verify and correct
the company /business
Omaha Door & Window Co., Inc. information listed here: j
4665 'G' St
Omaha, NE 68117
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 -733 -6440
Mobile
Email Address:
Type of Business: GENERAL
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Omaha Door & Window Co., General Certificate of Liability 4/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew Name License / Registration Expires Amount
Omaha Door & Window General Contractor 12/31/2011 $60
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 an y all der, requirements and regulations of its lawful constituted authorities.
Authorized Signature Date
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