OmahaD Registration 2014.tif - CITY OF BLAIR FOR OFFICE USE ONLY j
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218 S 16TH STREET
$ .r BLAIR, NE 68008 Date Paid:
(402) 426 - 4191 Receipt No:
Date Issued:
FAX (402) 426 - 4195 S44-1 —La
BOND EXPIRES -- - --
e � o Email: cityofblair @ci.blair.ne.us
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CONTRACTOR REGISTRATION / LICENSE RENEWAL —
Please verify and correct
the company /beaslness
Omaha Door & Window Co., Inc. information listed here:
4665 'G' St
Omaha, NE 68117
Phone numbers on record:
Type: Phone (Dumber: Type: Phone Number:
Office 402 - 733 -6440 2 �_ �-
Mobile
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
Omaha Door & Window Co., General Certificate of Liability 4/1/2014
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
X Omaha Door & Window 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 v ation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation a obey order, requirements and regulations of its lawful constituted authorities.
/ _
Authorized Signature Date