Local Small Business Enterprise (LSBE) Program Application

Local Small Business Enterprise (LSBE) Program Application

This application is for Savannah based small businesses to register to participate in the Local Small Business Enterprise (LSBE) Program. The LSBE registration supports the City of Savannah's Savannah First Initiative by facilitating a registry of Savannah-based small businesses who are eligible to respond to Savannah First procurement opportunities.

Applicants must have: (1) a physical operating presence evidenced by a City of Savannah Business Tax Certificate for not less than 1 year prior to application; (2) Have Gross Receipts (total of three year average) that does not exceed the identified revenue thresholds detailed below; (3) the Owner's Personal Net Worth (PNW) should not exceed $1.32 million.

A business that operates as a broker is not eligible for LSBE Program participation.

DIRECTIONS: Complete the application by responding to all questions completely. Be sure to sign the application by typing your full name in the "Attest" block, and clicking SUBMIT.

GENERAL BUSINESS INFORMATION

Name of Business*

Please list the complete name of your business here as it legally is registered. If your firm operates by under a "d/b/a" please include that name here as well.

Name of Business Owner or Point of Contact*

Please list the owner's name or point of contact.

Business Owner's Email Address:*

Business Website:*

Please list the website address of the business. If there is not one, please indicate, "N/A".

Business Physical Street Address*

Please do not list a PO Box. A physical address is required in this space.

Business's Mailing Address*

City/State/Zip*

Business Phone Number:*

Phone

Alternate Phone Number:

Phone

LOCAL SMALL BUSINESS REGISTRATION INFORMATION

The information shared in this section will help us understand your business and its compliance with the program guidelines. Please respond completely to the following questions.

Nature or Type of the Business*

(For Example - Retail, Catering, Construction, Consultant, Lawncare, Furniture Sales, Car Dealer, Printing, etc.)

What SERVICE or PRODUCT(S) does your business provide/sell in the ordinary course of operating with your customers, other than to the City of Savannah?*

Please be detailed in your response.

Please select the operational category that best applies to this business from the options below.*

Select or enter value

Date this business was started:*

Please list as MM/DD/YYYY or MM/YYYY in the space below.

SAVANNAH BUSINESS TAX CERTIFICATE: Does your business have a CURRENT Savannah Business Tax Certificate?*

Your business MUST be located within the geographic boundaries of the City of Savannah. Your business must have held a City of Savannah Business Tax Certificate for no less than one year prior to application, and is "current" for this year. (Please note, your response will be verified with the City of Savannah Revenue Department.)

YES

GROSS REVENUES: Over the past three years, did your average revenues exceed the threshold for it's category?*

Revenue Thresholds:

Construction: Less than $35,000,000 over the past three years

Materials and Supplies: Less than $7,000,000 over the past three years

Professional Services: Less than $5,000,000 over the past three years

General Services: Less than $3,000,000 over the past three years

Helpful Hint: Your business taxes or business Profit/Loss statement is how the criteria is determined and measured.

YES

UNSURE

UPLOAD PORTAL: Please upload the two (2) requested required documents here as described below.*

LEASE/OWNERSHIP DOCUMENTS: Upload your rental lease or ownership documents for your firm's office, retail, or storage space. If you own your operational location, provide proof of ownership here. Helpful Hint: If you own, a copy of your property card from the Chatham County Tax Assessor is acceptable. Go to, www.chathamtax.org.
PERSONAL NET WORTH WORKSHEET: Owner's personal net worth shall not exceed $1.32 million. Please access the fillable PDF worksheet link below. Complete the form, save it to your computer, then upload it to this portal. PDF WORKSHEET LINK: Personal Net Worth Worksheet

Drag and drop files here or

ATTEST LSBE APPLICATION AND SUBMISSION:*

I, the undersigned applicant, swear and affirm under penalty of law that I am the owner and legal representative of the business represented on this application for the Local Small Business Enterprise Program. I also affirm that I have read and understood the SBO Policy and the questions in this application and all response information provided herewith is true and correct to the best of my knowledge.

I acknowledge that any material or false statement or omission made in connection with this application is sufficient cause for denial of certification, registration, revocation of prior approvals, initiation of suspension, or removal from this program. Such false statements or omissions may subject the applicant to civil and/or criminal penalties available to the City of Savannah pursuant to any local, state, or federal laws.

I also recognize that the information submitted in this application is for the purposes of inclusion in the Local Small Business Enterprise (LSBE) Program which allows for certain procurement benefits with the city. I further understand that the City of Savannah may, by means it deems appropriate, reserve the right to investigate, follow up, or audit the accuracy and truthfulness of the statements provided within this application that I have provided. I understand that refusal to permit such an inquiry, follow up, or audit shall be grounds for denial of continued participation in the LSBE Program. By my signature below, I authorize the City of Savannah to contact any entity or entities named in this application for verification of the information provided pursuant to my eligibility.

I declare under penalty of perjury that my submission in this application is true and correct.

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