APPLICATION FORM -Clark County SBOP_2019
RequiredRequired Question(s)
Required 1.
Today's Date:
 

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Required 2.

Business Name:

 

50 characters left.
3.

DBA (Doing Business As):

 

50 characters left.
Required 4.
Number of Years in Business:
Less than a year
1 to 2 years
3 to 5 years
More than 5 years in business
5.

Located in Clark County District:



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District A (Michael Naft, Commissioner)
District B (Marilyn Kirkpatrick, Commissioner)
District C (Larry Brown, Commissioner)
District D (Lawrence Weekly, Commissioner)
District E (Tick Segerblom, Commissioner)
District F (Justin Jones, Commissioner)
District G (James B. Gibson, Commissioner)
Required 6.
Owner's First Name:
 

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Required 7.

Owner's Last Name:

 

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Required 8.
Point of Contact First Name (the person who will be enrolled and communicate with SBOP):
 

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Required 9.

Point of Contact Last Name:

 

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Required 10.

Point of Contact Email:

 

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Required 11.

Point of Contact Phone Number:

 

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Required 12.

Business Street Address:

 

50 characters left.
Required 13.

City: 

 

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Required 14.
State:
 

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Required 15.

Zip Code:

 

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Required 16.

Business Phone:

 

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Required 17.

Business Email:

 

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18.

Website:

 

50 characters left.
Required 19.
Briefly describe the type of products/services you provide: 

 

350 characters left.
20.
Please select the description which best describes 51% or more of the business ownership:
MBE - An independent & continuing business for profit, performs a commercially useful function and is at least 51% owned & controlled by one or more minority persons of Black American, Hispanic American, Asian-Pacific American or Native American ethnicity.
WBE - An independent and continuing business for profit which performs a commercially useful function and is at least 51% owned and controlled by one or more women.
ESB - Certified by the Nevada Governor's Office of Economic Development effective January, 2014. Approved into Nevada law during the 77th Legislative session as a result of AB294.
PBE - An independent and continuing business for profit which performs a commercially useful function and is at least 51% owned and controlled by one or more disabled individuals pursuant to the federal Americans with Disabilities Act.
SBE - An independent and continuing business for profit which performs a commercially useful function, is not owned and controlled by individuals designated as minority, women, or physically-challenged-
. Gross annual sales does not exceed $2,000,000.00.
VET - An independent and continuing Nevada business for profit which performs a commercially useful function and is at least 51 percent owned and controlled by one or more U.S. Veterans.
DVET - A Nevada business at least 51 percent owned/controlled by a disabled veteran.
Other  
21.
Company's certification status:
MBE (Minority-Owned Business Enterprise) - Certified
WBE (Woman-Owned Business Enterprise) - Certified
ESB (Emerging Small Business) - Certified
PBE (Physically Challenged Business Enterprise) - Certified
SBE (Small Business Enterprise) - Certified
VET (Veteran-Owned Business Enterprise) - Certified
DVET (Disadvantaged Veteran Business Enterprise) - Certified
Not Certified
22.
Please select the box that best applies to 51% or more of the business ownership: 

African American
American Indian or Alaskan
Asian or Pacific Islander
Caucasian
Hispanic
Other  
23.

NV State Business License Number (if applicable):

 

50 characters left.
24.

NV State Business License Expiration Date:

 

50 characters left.
25.
Clark County Business License Number (if applicable): 

 

50 characters left.
26.
Clark County Business License Expiration Date:
 

50 characters left.
27.
Other City/County Business License Number (if applicable): 

 

50 characters left.
28.
Other City/County Business License Expiration Date:
 

50 characters left.