PrairieC Registration 2014.tif CITY O BLA IR FOR OFFICE USE ONLY 1
4., 218 S 16TH STREET -�
BLAIR, NE 68008 Date Paid:
(402) 426 - 4191
Receipt No:
FAX(402)426 - 4195 Date Issued: j
Email: cityofblair@ci.blair.ne.us BOND EXPIRES
CON TRACTOR E I T ATI / LICENSE EN L
D Please verify and correct
Fit E
E the company business
Prairie Construction Company information listed here:
13316 B St
Omaha, NE 68144
MINE CONSTRUCTION CO-
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 330 8522
Fax 402 330 8544
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
Prairie Construction Co General Certificate of Liability 1/1/2014
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Prairie Construction Co 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
vocation and obey all order, r9quirements and regulations of its lawful constituted authorities.
�JA A),t 6_1 I p
uthorize Signature Date
YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED Olt. ABOUT
'T O EXPIRE. PLEASE SUBMIT A
NEW COI'Y I'�rH YOUR RENEWAL.