Downs Registration 2015.tif - CITY OF BLAIR
A FOR OFFICE USE ONLY
0 - 218 S 16TH STREET 4,
BLAIR, NE 68008 Date Paid: -/
Receipt No:-3
(402) 426 - 4191 p -
❑ Date Issued:
r FAX (402) 426 - 4195
Email: cityofbiair @ci.blair.ne.us BOND EXPIRES
I
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
PLEASE SUBMIT A COPY OF YOUR the company /business
Downs Electric, Inc. information listed here:
1808 Madison St CURRENT NEBRASKA DEPARTMENT OF
Omaha, NE 68107 LABOR REGISTRATION
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402- 733 -3080
Mobile Please submit a copy of current State
Email Address: Electrical License(s) expiring 12 /31/2016
Type of Business: ELECTRICAL GENERAL for all electricians registering.
Please submit new reciprocating license for those which have expired:
Name Reciprocating License Expires
Arett, Al Nebraska State Electrical Board License 12/31/2014
Downs, Dan L. Nebraska State Electrical Board License 12/31/2014
Hazelton, Art Nebraska State Electrical Board License 12/31/2014
Suden, Steve 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
Downs, Dan L. Electrical Bond 11/14/2015
Downs, Dan L. General Certificate of Liability 5/16/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
❑ Arett, AI Journeyman Electrical 12/31/2014 $25
❑ Downs, Dan L. General Contractor 12/31/2014 $60
❑ Downs, Dan L. Electrical Contractor 12/31/2014 $60
E aze t t ectrica Opp ( P-k
❑ Suden, Steve Journeyman Electrical 12/31/2014 $25
y �
ot tA�� �-e j
RECE IVED DEC 8 - 2014
i
i
Please list any additional license or registrations:
Name License / Registration Amount
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 d obey all order, r irements and regulations of its lawful constituted authorities.
Authorized nature Date
i
I
I
i
I
I
I
i
i
i
i
Department of Labor
Labor Law / Contractor Registration
R 550 South 16th Street, 3rd Floor
DEPARTMENT LABOR Lincoln, NE 68508
(402) 471 - 2239
i
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: DOWNS ELECTRIC, INC.
Address: 1808 MADISON ST
City: OMAHA j
I
State: NE
Zip: 68107
Telephone: (402) 733 - 3080
Certificate Number: 22868
Certificate Expiration: 01/01/2016
Contractor Option: 2
I
I
I
i
i