MidlandU Registration 2015.tif CITY OF BLAIR FOR OFFICE USE ONL
As 218 S 16TH STREET Date Paid: f —
�` BLAIR, NE 68008
Receipt No.
(402) 426 - 4191 Date Issued: —
°� r; FAX (402) 426 - 4195 BOND EX
Email: cityofblair @ci.blair.ne.us
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CONTRACTOR REGISTRATION / LICENSE RENEWAL �
Please verify and correct
the companylbusiness
Midland Utility Service, Inc. information listed here: j
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5240 Co Rd 40
Ft. Calhoun, NE 68023 — J
Phone numbers on record: Type: Phone Number: —
Type: Pho ne Number: YP
Office 402 573 5010 PLEASE SUBMIT A COPY OF Yv11R
Mobile 402 681 2015 CURRENT CITY OF OMAHA LICENSE
Email Address —
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Type of Business: DRAIN — — j
Please submit new reciprocating license for those which have expired:
Name Reciprocating License
Expires
Kimberling, Steve Omaha Plumber License
12/31/2014
Please submit new certificates or bond renewals for those which have expired:
Name
Certificate of Liability or Bond Expires
Kimberling, Steve
Drainlayer Bond 4/20/2015
Place a check in the box next to the licenses you wish to renew: Expires Amount
Renew? Name License / Registration
Drainla er 12/31/2014 $60
Kimberling, Steve Y
Please list any additional license or registrations: Amount
Name License / Registration
PLEASE SUBMIT A COPY OF YOUR
CURRENT NEBRASKA DEPARTMENT OF
LABOR REGISTRATION
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
vocatio} and obey al o er, requirements and regulations of its lawful constituted authorities.
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Au horzed Signature Date