Luxa Registration 2015.tif i
CITY OF RLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
Date Paid.
BLAIR, NE 68008 61r
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(402) 426 - 4191 Receipt No:
Date Issued:—
FAX (402) 426 - 4195
Email: cityofbiair @ci.blair.ne.us
BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Luxa Construction Company, Inc. information listed here:
925 E Dixon Rd
Blair, NE 68008
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402- 426 -2778
Mobile 402 510 8200
Email Address: —
Type of Business: G ENERAL —
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Luxa, Mike General Certificate of Liability 8/1/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Luxa, Mike General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
-----------------------------------------------------------
PLEASE SUBMIT A COPY 01 . YO 1R
CURRENT NEBRASKA DEPA ) N r Or
LABOR REOISTR % 'OIL
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 rder, requirements and regulations of its lawful constituted authorities.
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Date
Aut orized Signa ,ure
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Nebraska DepaMent of Labor
. Conrraci4r Reetstratlfin=
Y 53QSo 16th StreeE Lincoln, NE ;685D8 .:
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Date Issued Date Expires
10/01/2014 10/01/2015
r , CONTRACTOR REGISTRATION .CERTIFICATE
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Fee Paid: $40.00 Registration # -
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Business:
LUXA CONSTRUCTION. •COMPANY
PO BOX 105 ' £ + 4 C- .mner Ur
BLAIR, NE 68008 N
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