D&M Registration 2016.tifCITY OF BLAIR
218 S 16TH STREET
BLAIR, NE 68008
(402) 426 - 4191
FAX (402) 426 - 4195
Email: cityofblair@ci.blair.ne.us
FOR OFFICE USE ONLY
Date Paid: (- W- L
Receipt No:-1l�
Date Issued:
BOND EXPIRES'
CONTRACTOR REGISTRATION / LICENSE RENEWAL
DndM Roofing
t 51 --
OMAHA, NE 68116
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 402 289 4776 Mobile 402 250 5398
Fax '402 446 4o�-139- 8dV1y
Email Address:
Type of Business: General
Please submit new certificates or bond renewals for those which have expired:
Please verify and correct
the company/business
information listed here.
PLEASE SUBMIT #P OF •
LABOR
. SAO
a =11
RENEWAL.WITH YOUR
Name
Certificate of Liability or Bond
Expires
<d^ ,Fic
Oberembt, Eric
General Certificate of Liability
6/16/2015
�5
(o� 4X {
V\ew
Place a check in the box next
to the licenses you wish to renew:
Renew? Name
License / Registration
Expires
Amount
Oberembt, Eric
General Contractor
12/31/2015
$60
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 maa application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in abo said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vo do nd o e all order, requirements and regulations of its lawful constituted authorities.
Authorize Signature Date
11 -CRA
R
Nebraska Department of Labor
Contractor Registration
550 So 16th Street, Lincoln, NE 68508
(402) 471 - 2239
Date Issued
Date Expires
06/01/2015
06/01/2016
CONTRACTOR REGISTRATION CERTIFICATE
This cWiflufe is non-bansfemble
Fee Paid: $40.00
Registratlon #
41432 -
Year
15
Business:
DNDM ROOFING INC
17559 TAYLOR STREET
comm ssmnerott
OMAHA, NE 68116
11 -CRA