SBOP
Small Business
Opportunity Program
APPLICATION FORM -Clark County SBOP
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1. Today's Date:
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2. Business Name:
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3. DBA (Doing Business As):
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4. Number of Years in Business:
Less than 1 year
1 to 2 years
3 to 5 years
More than 5 years in business
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5. Located in Clark County District:
District A (Michael Naft, Commissioner)
District B (Marilyn Kirkpatrick, Commissioner)
District C (Ross Miller, Commissioner)
District D (William McCurdy, II, Commissioner)
District E (Tick Segerblom, Commissioner)
District F (Justin Jones, Commissioner)
District G (James B. Gibson, Commissioner)
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6. Owner's First Name:
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7. Owner's Last Name:
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8. Point of Contact First Name (the person who will be enrolled and communicate with SBOP):
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9. Point of Contact Last Name (the person who will be enrolled and communicate with SBOP):
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10. Point of Contact Email:
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11. Point of Contact Phone Number:
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12. Business Street Address:
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13. City:
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14. State:
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15. Zip Code:
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16. Business Phone:
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17. Business Email:
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18. Website:
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19. Briefly describe the type of products/services you provide:
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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
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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
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23. NV State Business License Number (if applicable):
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24. NV State Business License Expiration Date:
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25. Clark County Business License Number (if applicable):
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26. Clark County Business License Expiration Date:
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27. Other City/County Business License Number (if applicable):
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28. Other City/County Business License Expiration Date:
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Submit Application
