Rodgers Registration 2014.tif c
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Aug.08.2014 03:35 PM RODGERS CONST 4025474955 PAGE. 1� 1
Aug 0814 03,44p pubis lnsurs�nce Ageney 402 - 426 -8800 P _
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CITY BLAM ' FOR OFFICE slr O NLY ¢
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Blair, 6800 �* n�,.,,. . ;' Rate
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Email:
Appikation is: New Rene al
CONTRACTOR I
RIEG ISTRATION/LI CENSE RENEWAL
# Please Wpe or p rint In ink - If YOu need mo space, please attach addltionar sheets)
Application is for., Eontractor W,00 Q Electrical contractor 60. 0
* Water Servi Lire I - $60. ® Tree Trimme - $60.00
* FirglS+eWrlty System Installer - $25M � Gas Line Installer . $Z!j,O()
0 Mechani contractor - $60. Plumbing Contractor $60,)
LJ Drain Layer W $60.00
SUSInesS Name;
Applicant Name:
Buines Ad �'r r Pv-
cjty: S#teip�
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EM011 Address:
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Phone C F: . 11102-4 ,,.��,., ` Mobile 0-
0usiness Address outside of Nebraska,
City; State ._ zip: Mona:
Contact Person:
Number Of Employees: Apprentices: Journeymen:
Futter LiC enses Held:
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Insurionce/Worker's Compensation Compan
Mait, L Yers /Llectricak Plumbing and Methanicaf tantr ctOts/Water $ mice Line rn"11ers need a $SAM permit bon in favor
Of the Clty Of Muir. Tree 'lrrlrr mers rr d a $ 5,000 permit Jbortd in ftvor of the city of Blair. ElectriCal Contractor anal l 11r
curl' System lnMllef will need tosubn* .a copy of your Nahyas a ate Lice.
General cantractors need try submit a Cenific.,at+e Of Insurance with minimum 11mits of $1 ,000,000 AggregetW$300, each
accUtrrnce,
All Information contained In this applicati is true ana Correct. A YAII notify the city of Blair p f an changes in the Inn I r mstron
reported on or with this application fbrm v4thin 15 days of the change,
I hereby make application to the lAcensing Board of Blair, Nebraska and certify that 1 am competent and +eXperi ryct -d to
en9uge in above Said Vocation. 1 ag tc conform strimy to the orainanees of that city of BiRlr, Nebraska re lat iv to sai
vacation and obey all order. requirements and regulations Of its lawfut Mnstltuted authorities. This ce rtification apps s to the
orlglnal license and/or registration anci any renewals thereof.
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Department of Labor
Labor Law / Contractor Registration
NEBRASKA EBRA, A
550 South 16th Street, 3rd Floor
DEPARTMENT OF _ LABOR Lincoln, NE 68508
(402) 471 -2239
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: RODGERS CONSTRUCTION
Address: 1951 COUNTY ROAD 17
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City: COLON
State: NE
Zip: 68018
Telephone: (402) 647 - 4955
Certificate Number: 25704
Certificate Expiration: 10/01/2014
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Contractor Option: 3
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Department of Labor
4 wiN E R A S A Labor Law / Contractor Registration
550 South 16th Street, 3rd Floor
DEPARTMENT LABOR Lincoln, NE 68508
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(402) 471 - 2239
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Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: RODGERS CONSTRUCTION
Address: 1951 COUNTY ROAD 17
City: COLON
State: NE
Zip: 68018
Telephone: (402) 647 - 4955
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Certificate Number: 25704
Certificate Expiration: 10/01/2014
Contractor Option: 3
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