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MidlandU Registration 2013.tif CITY OF BLAIR FOR OFFICE USE ONLY 218 S 16TH STREET BLAIR, NE 68008 Date Paid: �r- (402) 426 - 4191 Receipt No: FAX (402) 426 - 4195 Date Issued: j Email: cityofblair @ci.blair.ne.us BOND EXPIRES CONTRACTOR REGISTRATION / LICENSE RENEWAL j Please verify and correct Midland Trenching the company /business information listed here: 5240 Co Rd 40 Ft. Calhoun, NE 68023 Phone numbers on record: Ty pe: Phone Number: Type: Phone Number: Office 402 573 5018 Mobile 402 6812015 Email Address: Type of Business: Plep� sclbtaait new certificates or bondrenewalsforthose which have expired. arx�e ,Certificate of liability or Bond Expires llfnidrling, Steve Drainlayer Bond 4/20/2©12` Place a check in the box next to the licenses you wish to renew: Renew? Name License / Registration Expires Amount ❑ Kimberling, Steve Drainlayer 12/31/2012 $60 Please list any additional license or registrations: Name License / Registration Amount - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - IA- 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 vo tion and obey II o dqr, r quir ents and regulations of its lawful constituted authorities. ��thorizecl Signature Date f�1' �1m4 rt 2. i l3 Cr��v �,�'�'