TotalC Registration 2013.tif i
CITY OF BLAIR FOR OFFICE USE ONLY
— 218 S 16TH STREET
Date P _
aid :.®
BLAIR, NE 68008
.�
(402) 426 - 4191 Receipt No:
� Date Issued: —
y�� FAX (402) 426 - 4195 �, �
Email: cityofblair @ci.blair.ne.us
BOND EXPIRES:- -
CONTRACTOR REGISTRATION / LICENSE RENEWAL
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:
Type: Phone Number: Type: Phone Number:
Office 402 572 7457
Mobile 402 306 0340 i
Email Address:
Type of Business: GENERAL
i
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Jackson, Kevin General Certificate of Liability 3/1/2013
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
❑ Jackson, Kevin General Contractor 12/31/2012 $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 a bey all o e irements and regulations of its lawful co ns tituted authorities.
orized Si Lure Date