Natureworks Registration 2013.tif CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
Date Paid:
BLAIR, NE 68008
6,
(402) 426 - 4191 Receipt No:
r FAX (402) 426 - 4195
Date Issued:
Email: cityofblair@ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
i
NatureWorks LLC information listed here:
650 Industrial Park Dr
Blair, NE 68008
Phone numbers on record:
Type: Phone Number: Type: Pho Number:
Office 402 533 1400 Office 'jdj ' - 1 -.36 c c
v,� °Z� 7 -3
Office 402 533 1422
Email Address: s'-kue
Type of Business: General
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Dennis Bravo General Certificate of Liability 12/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
X Dennis Bravo General Contractor 12/31/2012 $60
Please list any additional license or registrations: Amount
Name License / Registration
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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 d obey a� order,, equirements and regulations of its lawful constituted authorities.
" 's&z'zvo Signature Date