Infinity Registration 2015.tif I
- w CITY OF BLAIR FOR OFFICE USE ONLY i
218 S 16TH STREET
�I BLAIR, NE 68008 Date Paid
(402) 426 - 4191
Receipt No:
Date Issued: —
FAX (402) 42 6
BOND EXPIRES
`1pk3o Email: cityofbiair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEWAL i
Please verify and correct
the company /business
Infinity Roofing & Siding, Inc. information listed here:
10685 Bedford Ave
OMAHA, NE 68154
Phone numbers on record:
Type: Phon Number: Type: Phone Number:
Office 888 855 2331 Office
Fax 888 3719080 i
Email Address:
Type of Business: Ge neral
Please submit new certificates or bond renewals for those which have expired:
Name
Certificate of Liability or Bond Expires
Lindsey, Derek
General Certificate of Liability 1/22/2015
�
Place a check in the box next to the licenses you wish to renew:
Rene ? Name
License / Registration Expires Amount
Lindsey, Derek General Contractor 12/31/2014 $60
Please list any additional license or registrations: Amount
Name License / Registration
---------------------------------------------
YOUR CERTIFICATE OF LIABILITY PLEASE SUBMIT A COPY OF YOU
INSURANCE IS EXPIRED OR ABOUT TO CURRENT NEBRASKA DEPARTiZfIIrI 1 ray=
EXPIRE, PLEASE SUBMIT A NEW C_ PY LABOR REGISTRATIO
WITH YOUR RENEWAL.
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, requirements and regulations of its lawful constituted authorities.
C R
Authorized Signature Date