City of North Las Vegas
On-Site Quality Assurance Agency Application

Name of Agency

State License Number

North Las Vegas Business License Number

Address

Company Phone Number

Company Email Address

Name of Quality Manager

Quality Manager Phone Number

Quality Manager Email Address

Name of Engineering Manager

Engineering Manager Phone Number

Engineering Manager Email Address

The company has personnel who is nationally certified as a Fire Inspector?

Yes

No

The company has personnel who is nationally certified as a Plumbing Inspector?

Yes

No

Current liability insurance available?

Yes

No

Liability Insurance Amount

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