PrairieC Registration 2015.tif _ CITY OF BLAIR FOR OFFICE USE ONLY
f r 218 S 16TH STREET l �
a Date Paid:
BLAIR NE 68008 —
' (402) 426 -4191 Receipt No:
4
t .�rvv
Date Issued: —
t FAX (402) 426 - 4195 � BOND EXPIRE i
Email: cityofblair@ci.blair.ne.us —
CONTRACTOR REGISTRATION / LICENSE RENEWAL
-
VED
Please verify and correct
k� the company /business
Prairie Construction Company information listed here:
13316 B St Q ZQ)�
Omaha, NE 68144
PMIRI . CCNsT uC ri ®N Co. —
Phone numbers on record:
Type: Phone Number: Type: Phone Number: _
Office 402 330 8522
Fax 402 330 8544
Email Address: matt @pra construct
Type of Business: G ENERAL
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Prairie Construction Co General Certificate of Liability 1/1/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
[XI Prairie Construction Co General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
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YOUR CERTIFICATE OF LIABILITY
INSURANCE IS EXPIRED OR ABOUT TO PLEASE SUBMIT A COPY OF YOUR
EXPIRE. PLEASE SUBMIT A NEW COPY CURRENT NEBRASKA DEPARTMENT OF
I -AB R RFGI.ST A,TION
WI TH YOUR RENEWAL.
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 order, requirements and regulations of its lawful constituted authorities.
12/23/14
Au orized Signature Date