QualityF Registration 2013.tif _ CITY OF BLAIR FOR OFFICE USE ONLY
a
218 S 16TH STREET
BLAIR, NE 68008 Date Paid: � �3 1
Receipt t No: � � S
(402) 426 - 4191 P
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
Quality Fence information listed here:
17716 Storage Rd
Omaha, NE 68136
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 896 9325 F—AX 4o 7t- 1 " 1 4 GCS - 4(,-
Mobile
Email Address:
Type of Business: FENCES
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Quality Fence General Certificate of Liability 6/3/2013
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Quality Fence General Contractor 12/31/2012 $60
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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
vocatio and obey all order, requirements and regulations of its lawful constituted authorities.
Y 77� A
Authorized Signature Date