Natureworks Registration 2015.tif i
CITY OF BLAIR FOR OFFICE USE ONLY
!' 218 S 16TH STREET
BLAIR, NE 68008 Date Paid:
(402) 426 - 4191 Receipt No:
��`� • ' ` ��,� FAX (402) 426 - 4195
Date Issued:
Email: cityofblair @ci.blair.ne.us BOND EXPI —
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CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
NatureWorks LLC information listed here.
650 Industrial Park Dr
Blair, NE 68008
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Phone numbers on record:
Type: Phone Number: Type: -- Phon Num
Office 402 237 3841 Fax 402 237 3801
Office 402 306 6984
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
Sheehan, John General Certificate of Liability 12/1/2014
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Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Sheehan, John General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
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YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRE R ABOUT T PLEASE SUBMIT � CO k YOUR
EXPIRE, PLEASE SUBMIT ANEW COPY
CURRENT NEBRASKA EOEPAR`(�lIENT OF
WITH YOUR RENEWAL,
LABOR REGISTRATION
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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, requirements and regulations of its lawful constituted authorities.
' thorized Signature Date
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