Pre-Application for Douglas County Small Business Program to support Data Center Development

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* 1. Business Contact Information

Legal Company Name

DBA Name (if applicable)

Physical Business Address (including City, State, Zip)

Mailing Address

Business Phone Number

Primary Contact Person Name

Primary Contact Person Title

Primary Contact Person Email

Primary Contact Person Phone #

Second Point of Contact Person Name

Second Point of Contact Person Title

Second Point of Contact Person Email

Second Point of Contact Person Phone #

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* 2. Please upload the business Secretary of State Filing

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* 3. Please upload 2025 Business License

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* 4. Please select your primary NAICS code from the dropdown menu.

Other (please specify)

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* 5. Please select an additional NAICS code from the dropdown menu.

Other (please specify)

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* 6. Please select an additional NAICS code from the dropdown menu.

Other (please specify)

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* 7. Please select an additional NAICS code from the dropdown menu.

Other (please specify)

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* 8. Please select an additional NAICS code from the dropdown menu.

Other (please specify)

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* 9. Please upload you CV/Resume of Previous Contracts/Work Experience

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* 10. Please upload your capabilities statement.

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* 11. Please list any certifications or designations held by the company.

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* 12. Please upload a copy of your Commercial General Liability Insurance.

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* 13. What is your three-year average revenue?

Under $500,000

$500,000 - $1,000,000

$1,000,000-$5,000,000

More than $5,000,000

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* 14. Please upload a recent P&L statement

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* 15. Do you need funding?

Yes

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* 16. What year was the company founded?

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* 17. Number of FTE employees.

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* 18. Number of 1099 contractors.

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* 19. Disclaimer Statement: I understand that completion of this pre-application to participate in a Small Business Initiative and acceptance into the program does not guarantee any contracts or direct bid opportunities.

Agree

Disagree

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* 20. Disclaimer Statement: I understand that I may be asked to sign an NDA as a requirement for participation in the Small Business Program and failure to comply will automatically result in my removal from consideration.

Agree

Disagree

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* 21. Disclaimer Statement: I understand that as part of the Small Business program, I may be asked to partner or collaborate with other businesses, including opportunities for sub-contracting and partner bids to expand business capacity.

Agree

Disagree