ABC Registration 2014.tif CITY F BL AIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68008 Date Paid: / ®1
Receipt No:
(402) 426 m 4191
FAX (402) 426 - 4195 Date Issued:
Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGITR TI / LICENSE RENEWAL j
Please verify and correct
the company/business
ABC Seamless of Omaha
information listed here:
8032 Maple St
Omaha, NE 68134
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 3914500 Fax 402 3914500
Mobile 308 379 3369
i
Email Address:
Type of Business: General Contractor
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Franssen, Ted General Certificate of Liability 8/29/2013
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Franssen, Ted General Contractor 12/31/2013 $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
v 'Dc -a all order, requirements and regulations of its lawful constituted authorities.
Authorized Signature Date
YOUR CERTIFICATE OF LIABILITY
INSURANCE RLEAS SI7 MI A T
TO EXPIRE
NEW COPY WITH YOUR RENEWAL.