Thank you for expressing an interest in becoming a contracted provider with Clark County Social Services for the Skilled Nursing Facility 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 following documents to gain an understanding of the scope of this project, its services and specific regulations.

• Request for Qualifications Skilled Nursing Facility
• Scope of Work

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:

Skilled Nursing Facility Smartsheet Application

• Attachment 1: Cover Letter (County-issued form)
• Attachment 2: Organizational Information (County-issued form)
• Attachment 3: Organizational Chart
• Attachment 4: Skilled Nursing Facility Licensure
• Attachment 5: Sample Contract Acceptance Statement
• Attachment 6: Disclosure of Ownership (County-issued form)
• Attachment 7: Business License
• Attachment 8: W-9 (County-issued form)
• Attachment 9: 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.

Attachment 1: Cover Letter

See the “Reference Library” below for the County-issued cover letter template.

Attachment 2: Organizational Information

See the “Reference Library” below for the County-issued Organizational Information template.

Attachment 3: Organizational Chart

Provide your agency’s organizational chart.

Attachment 4: Skilled Nursing Facility Licensure

Provide the most recent State of Nevada, Department of Health and Human Services, Division of Public and Behavioral Health, Bureau of Health Care Quality and Compliance survey including current grade which are held by applicants and any proposed subcontractors.

Or

Provide the equivalent license, survey and current grade for the state in which the applicant’s facility is located outside of Nevada.

Attachment 5: Sample Contract Acceptance Statement

Please review the standard County contract here.   Do not submit a copy of this contract. To indicate that your agency accepts the terms and conditions laid out in the County contract, please submit the following signed statement on agency letterhead:

“[AGENCY NAME] has no exceptions to the sample contract.”

The letter must be signed by an authorized agency representative.

Attachment 6: Disclosure of Ownership (County-issued form)

See the “Reference Library” for the County-issued Disclosure of Ownership template. For step-by-step instructions, please see the Disclosure Form – Example

Attachment 7: 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 8: Attachment 8: W-9 (County-issued form)

See the “Reference Library” for the County-issued W-9 template.

Attachment 9: Supplier Maintenance Form

See the “Reference Library” for the County issued template.