PrairieC Registration 2013.tif sx.. CITY OF BLAIR FOR OFFICE USE ONLY
= � 218 S 16TH STREET �
Date Pai
NE 68008 d: � I
BLAIR,
(402) 426 - 4191 Receipt NO: -3A9 6 ( 7 3 --
y,;� FAX (402) 426 - 4195 Date Issued:
moo �y Email: cityofbiair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Prairie Construction Company information listed here:
13316 B St
Omaha, NE 68144
i
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 330 8522
Fax 402 330 850
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
Prairie Construction Co General Certificate of Liability 1/1/2013
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
X Prairie Construction Cc General Contractor 12/31/2012 $60
Please list any additional license or registrations:
Name License / Registration Amount
--------------------------------------------------------------------------------------------------------------------------------------------
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
ge i above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocatio an II o er, r quirements and regulations of its lawful constituted authorities.
Authorized Signature Date