TotalC Registration 2012.tif i
CITY OF BLAIR FOR OFFICE US:ON
218 S 16TH STREET
BLAIR, NE 68008 Date Paid:-f (402) 426 - 4191 Receipt No:
E FAX (402) 426 - 4195 Date Issued:
BOND EXPIRES
c ""fs i Email: cityofbiair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEW
Please verify and correct
the company /business
Total Construction Services, Inc. information listed here:
6727 N. 56th St
Omaha, NE 68152
Phone numbers on record:
Ty pe: Phone Number: Type: Phone Number:
Office 402 572 7457
Mobile 402 306 0340
Email Address: —
Type of Business: G
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Kevin Jackson General Certificate of Liability 3/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount j
Kevin Jackson 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 j
vocation and obey all or irements and regulations of its lawful constituted authorities.
ut ized Signre Date
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