Thank you for expressing an interest in becoming a contracted provider with Clark County Social Services for the Adult Day Care program.  The original solicitation has closed. However, interested applicants are able to apply for funding consideration at any time for the duration of the program through this process. Please review the Scope of Work to gain an understanding of the scope of this project, its services and specific regulations. All applications will be submitted through a Smartsheet Application, the required attachments must be uploaded to the Smartsheet Application.

To submit a complete Application Package, the following components must be provided:

Adult Day Care  Smartsheet Application

• Attachment 1: Signed Business Associate Agreement (County-issued form)
• Attachment 2: Licensure(s)
• Attachment 3: Business License
• Attachment 4: W-9 (County-issued form)
• Attachment 5: Supplier Maintenance Form (County-issued form)

Additional Instructions:

To receive a copy of the application, when submitting the Smartsheet Application, please click “Send me a copy of my responses” and a copy of your application will be emailed to the “Applicant Point of Contact Email” provided in the application.

If you have any questions related to this application process, please contact the Project Development Team at SSPDT@ClarkCountyNV.gov.

Please note, as part of the application process, an unannounced site visit will be conducted by the Adult Care Services team.

Attachment 1: Business Associate Agreement

To complete this agreement please ensure you have completed the following:

• Enter agency name on the line of page 1
• Agency Representative signature under BUSINESS ASSOCIATE section on page 15

Attachment 2: Licensure(s)

Upload the following applicable and most recent license(s):

• Department of Health and Human Services, Division of Public and Behavioral Health (DPBH) Bureau of Health Care Quality and Compliance (HCQC) License
• Any other applicable state licensure

Attachment 3: Business License

A. Clark County Business License is required if:

• A business is physically located in unincorporated Clark County, Nevada.
• The work to be performed is located in unincorporated Clark County, Nevada.

B. Register as a Limited Vendor Business Registration if:

• A business is physically located outside of unincorporated Clark County, Nevada.
• A business is physically located outside the state of Nevada.

The Clark County Department of Business License can answer any questions concerning determination of which requirement is applicable to your firm. It is located at the Clark County Government Center, 500 South Grand Central Parkway, 3rd Floor, Las Vegas, NV or  you can reach them via telephone at (702) 455-4340.

You may also obtain information on-line regarding Clark County Business Licenses by visiting the website.

Attachment 4: W-9

See the “Reference Library” below for the W-9.

Attachment 5: Supplier Maintenance Form

See the “Reference Library” below for the County-issued Supplier Maintenance Form.