PremierEx Registration 2015.tif I
.. CITY OF BLAIR FOR OFFICE USE ONLY j
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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 ND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Premier Exteriors Inc information listed here:
4780 S 131st St 'ter ke /
OMAHA, NE 68137
Phone numbers on record:
Type: Phone Number: Type: P hone Numbe
Office 402 679 6000 Office
Fax 402 502 9490
Email Address: , :I/ It
Type of Business: GENER
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Pull, James General Certificate of Liability 3/30/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Pull, James General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
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PLEASE SUBMIT A Copy or vnUR
CURRENT NEBRASKA DEPAR3 AL iT C r
LABOR REGISTRATION
All information contained in this application is true and correct. I will notify the City of Blair of a 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
vo tion and obey all order, requirements and regulations of its lawful constituted authorities.
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Authorized ignature Date
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Department of Labor
Labor Law / Contractor Registration
N E B 1 A S A 550 South 16th Street, 3rd Floor
DEPARTMENT OF LABOR I
Lincoln, NE 68508
,- (402) 471 -2239
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: PREMIER EXTERIORS INC
Address: 4780 SO 131 st ST SUITE 131
City: OMAHA
State: NE
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Zip: 68137
Telephone: (402) 679 - 6000
Certificate Number: 42740
Certificate Expiration: 01/15/2016
Contractor Option: 2
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