TotalC Registration 2015.tif I
CITY OF BLAIR FOR OFFICE USE ONLY
w' 218 S 16TH STREET J�j
..,
BLAIR, NE 68008 Date Paid:
(402) 426 - 4191 Receipt No:
Date Issued: -
FAX (402) 426 - 4195
Email: cityofblair @ci.blair.ne.us BO ND EXPIRES
G
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Total Construction Services, Inc. information listed here:
6727 N. 56th St
Omaha, NE 68152
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 572 7457
Mobile 402 306 0340
Email Address: VN�F
Type of Business: GE NERAL
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 3/1/2015
I
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Jackson, Kevin General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
PLEASE SUBMIT A COPY F YOUR
CURRENT E S E T OF
LABOR REGISTRATI
C
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
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, gree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and o al , r uirements and regulations of its lawful constituted authorities.
7,�
�t rizecl Si ature Date
i
i
i
j
4
c
Nebraska Department of Labor "
Contractor Registration
550 So. 16th Street, Lincoln, NE 68508
(402) 471 - 2239 I
1
I
Date Issued Date Expires.
11/01/2014 11/0 1 /2015
CONTRACTOR REGISTRATION CERTIFICATE
This certificate is non -1 5gn ferahle
Fee Paid: $40.00 Registration #
22188,
Year
14
Business:
TOTAL CONSTRUCTION SERVICE
6727 NORTH 56TH STREET commiss;oner orL r
OMAHA, NE 68152
I
i
i
I
I
4
i