D&M Registration 2015.tif I
_ CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
s BLAIR, NE 68008 Date Paid:
(402) 426 - 4191 Receipt No:
FAX (402) 426 - 4195
Date Issued:
fo Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
DndM Roofing information listed here:
17559 Taylor St
OMAHA, NE 68116
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 289 4776 Mobile 40'2 250 5398
Fax 402 289 4446
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
erembt, Eric General Certificate of Liability 6/16/2015
Place a check in the box next to the licenses you wish to renew:
Rene Name License / Registration Expires Amount
k berembt, Eric General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
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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 abov ai /vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
catio , d obe II order, requirements and regulations of its lawful constituted authorities.
T
Authorized Signature Date
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4ENEBRASKA Department of Labor
Labor Law / Contractor Registration
550 South 16th Street, 3rd Floor
DEPARTMENT OF LABOR Lincoln, NE 68508
(402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: DndM Roofing Inc
Address: 17559 Taylor Street
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City: Omaha j
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State: NE
Zip: 68116
Telephone: (402) 289 - 4776
Certificate Number: 41432
Certificate Expiration: 06/01/2015
Contractor Option: 2
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