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INSTRUCTIONS FOR COMPLETING THE LOCAL SMALL BUSINESS OPPORTUNITY PROGRAM (LSBOP) APPLICATION All questions must be answered and the requested documents submitted. The signatures of the owner(s) applying for registration must be notarized on the Registration Affidavit. Failure to follow these instructions may delay the processing of the application. Questions that do not apply to your firm should be marked “N/A” in the space provided. SECTION I – GENERAL APPLICANT INFORMATION 1. Complete a registration application for each person who has an ownership interest in the business. The telephone number and business address should be for your main office. Be sure to include area codes for all phone and fax numbers. Also, give the web site for your firm. If your company has a Federal Employer Identification Number (EIN), please provide that number. If not, please provide the Social Security number listed on the firms’ tax return. 2. Check the type of business structure of your company. Provide the date that the business was started or was purchased by the applicant owner(s) listed in Section I above. If you operate your business out of your home, please check YES. 3. Indicate the number of full-time and part-time employees and enter the total. 4. Refer to the NAICS (North American Industry Code Standards) code listing and provide the code(s) that best describes the service, product or work of the firm. NAICS listings can be found on the internet at http://www.naics.com/search.htm or at your local library. 5. Provide the name of your bonding agent and the firm’s current bonding capacity. (If applicable) 6. Write a brief description of your firm’s primary product, service, or work area. Then add three supporting descriptives which clarify and identify your specific product, service, or area of work. This is how your firm will be described in the Registration Directory should you be granted registration. For instance: Wholesaler: Construction Supplies – Plumbing Supplies – Electrical Supplies. 7. Check the type of business activity which best describes your services. SECTION II – FINANCIAL INFORMATION 8. List the gross earnings of the company for the three most recent years. This amount should match the gross earnings listed on the business tax returns for the firm. Please include copy of the forms below: Form 1120 Corporation Form 1120s Subchapter or S Corporation Form 1065 Partnerships Form 1040 Schedule C – Sole Proprietorship Schedule F - Farm ---PAGE BREAK--- SECTION III – OWNERSHIP 9. Indicate if the ownership interest of any of the owners has changed since the business was started or was purchased. If a change has occurred, tell us when (date) the change occurred. 10. List the name of current members of the Board. Please show the ownership percentage owned by the individual(s), and/or the position held in the company. 11. List the personal net worth of all owners and their ownership percentage in the business. SECTION IV – EXPERIENCE 12. List the three largest contracts or sales completed by the firm during the last three years. List each Customer’s name and company or organization, the dollar amount of each contract or sales, and the date completed. 13. Indicate if the business has an Augusta-Richmond County current business license. Please include a copy of Augusta-Richmond County and relevant licenses pertaining to the company profession. 14. Indicate if the company is certified with any other certifying agency. Please include copy of certificate(s). REGISTRATION AFFIDAVIT (MUST BE COMPLETED BY ALL OWNER(S) The affidavit must be notarized. False statements shall make your firm subject to decertification and/or denied future certification. This form is required for all owners. SUPPORTING DOCUMENT CHECKLIST All applicants MUST follow the checklist for documentation that is required with the application. Return the completed LSBOP application to: Disadvantaged Business Enterprise Department 501 Greene Street – Suite 304 Augusta, Georgia 30901 LSBOP – Registration Application 3/9/08