OmahaD Registration 2013.tif CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
I
BLAIR, NE 68008 Date Paid: f '1 a
(402) 426 - 4191 Receipt No:
FAX (402) 426 - 4195 Date Issued:
r 'st� a Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Omaha Door & Window Co., Inc. information listed here:
4665 'G' St
Omaha, NE 68117
Phone numbers on record:
Type: Phone Number: Type: Phone Number: j
i
Office 402 - 733 -6440 j
Mobile
Email Address:
Type of Business: GENERAL
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Omaha Door & Window Co., General Certificate of Liability 4/1/2012
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Omaha Door & Window General Contractor 12/31/2012 $60
Please list any additional license or registrations:
Name License / Registration Amount
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I
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 and obey all order, rg and regulations of its lawful constituted authorities.
Authorized Signature Date