Luxa Registration 2014.tif CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68088 Date Paid:
ua +
(402) 426 m 4191 Receipt No:
FAX (402) 426 - 4195
Date Issued
BOND EXPIRES
Email: cityofblair @ci.blair.ne.us - - - - - --
ca, -_-
CONTRACTOR E ITRATI / LICENSE RENEWAL
Please verify and correct
the company /business
Luxa Construction Company, Inc. information listed here:
925 E Dixon Rd
Blair, NE 68008
Phone numbers on record:
Type: Phone Number: type: Phone Number:
Office 402 - 426 -2778
Mobile 402 510 8200
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
Luxa, Mike General Certificate of Liability 8/1/2013
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Luxa, Mike General Contractor 12/31/2013 $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
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, requirements and regulations of its lawful constituted authorities.
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Authorized Signature Date
Y OUR CERTIFICATE OF LIABILITY
Y
INSURANCE IS EXPIRED OR ABOUT
TO EXPIRE, PLEASE SUBIV IT° A
NEW COPY WITH YOUR RENEWAL.