TotalC Registration 2014.tif CITY OF B LAIR
FOR OFFICE USE ONLY
218 S 16TH STREET
-:` BLAIR, NE 68008 Date Paid: m 0 E
Receipt No:
4191
u (402) 426 m
FAX (402) 426 m 4195 Date Issued:
Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENE
Please verify and correct
the company business
Total Construction Services, Inc. information listed here:
6727 N. 56th St
Omaha, NE 68152 !
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Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 572 7457
Mobile 402 306 0340
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
Jackson, Kevin General Certificate of Liability 3/1/2014
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Jackson, Kevin General Contractor 12/31/2013 $60
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Please list any additional license or registrations:
Name License / Registration Amount
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will notify the Ci of Blair of an changes his application is true and correct. I y y Y es in the g
All information contained in t pp
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 a d o y all or irements and regulations of its lawful constituted authorities.
_�--- orized Sili9Are Date
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