Prime Registration 2015.tif _ CITY OF RLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68008
Date Paid: I o
Receipt No:-
- r'' (402) 426 - 4191 Date Issued:
FAX (402) 426 - 4195
B OND EXPIRES
Email: cityofbiair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEW
Please verify and correct 1
the companylbusiness
Prime Electrical Services LLC information listed here:
PO Box 4854 j
OMAHA, NE 68104
Phone numbers on record:
Type: Phone Number: Type Phone Number:
Office X602 960 1667 Office
Office
Email Address:
P1@a a now par it bond and eo pg of
Type of Business: ELECTRICAL 9tate Electrieal r (P.) w ith rang aL
Please submit new reciprocating license for those which have expired:
Name Reciprocating License Expires
Kyle, Rick Nebraska State Electrical Board License 12/31/2014
Swanson, Russell Nebraska State Electrical Board License 12/31/2014
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires f l
Kyle, Rick Electrical Bond 11/20/2014
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
❑ Kyle, Rick Electrical Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
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PLEASE SUBMIT A COPY OF YOUR
I
CURRENT NEBRASKA DEPARTMENT OF
LABOR REGISTRATION
i
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 a e application. the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
a .
en gag in a ove said voc ion. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
voca ion o I equirements and regulations of its lawful constituted authorities.
2 1�
A raze ig at re Date