PrairieC Registration 2012.tif v - ^` CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68008 Date Paid:
.`� (402) 426 - 4191 Receipt No:�
Date Issued:
FAX (402) 426 - 4195 BOND EXPIRES
Email: cityofblair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEWA
Please verify and correct
the company /business
Prairie Construction Company information listed here.
13316 B St Ad
Omaha, NE 68144
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 330 8522
Mobile Fax: 402 330 86 X DEC 2 Q Z � 1
Email Address:
Type of Business: GENERAL PRAIRIE CONSTRUCTION CO.
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
General Certificate of Liability 1/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
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
ocat n o all der, requirements and regulations of its lawful constituted authorities.
Authorize ure Date
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