QualityF Registration 2012.tif CITY OF BLAIR FOR OFFICE USE ONLY
' q 218 S 16TH STREET
BLAIR, NE 68008 Date Paid:
i t No:
Recei =
(402) 426 - 4191 p
FAX(402)426
-4195 Date Issued:
� e c � Email: cityofblair @ci.blair.ne.us BOND EXPIRES
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CONTRACTOR REGISTRATION / LICENSE RENEWA
Please verify and correct
the company /business
Quality Fence information listed here.
17716 Storage Rd dd
Omaha, NE 68136
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Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 896 9325
Mobile
Email Address:
Type of Business: FE NCES
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
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Quality Fence General Certificate of Liability 6/3/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Quality Fence General Contractor 12/31/2011 $60
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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.
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 do ey a de/, requirements and regulations of its lawful constituted authorities.
Authorized Signature Date
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