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QAA Agency
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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
*
Phone
form field Company Phone Number
must be in the format: (000) 000-0000
Company Email Address
*
Email
form field Company Email Address
is not in correct form
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?
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?
The company has personnel who is nationally certified as a Plumbing Inspector?
Yes
No
Current liability insurance available?
Current liability insurance available?
Yes
No
Liability Insurance Amount
*
-- Select one --
$ (USD, US Dollar)
€ (EUR, Euro)
¥ (JPY, Japanese Yen)
£ (GBP, British Pound)
Fr (CHF, Swiss Franc)
$ (CAD, Canadian Dollar)
$ (AUD, Australian Dollar)
$ (HKD, Hong Kong Dollar)
R$ (BRL, Brazilian Real)
$ (CLP, Chilean Peso)
¥ (CNY, Chinese Yuan Renminbi)
Kč (CZK, Czech Koruna)
kr (DKK, Danish Krone)
Ft (HUF, Hungarian Forint)
₹ (INR, Indian Rupee)
Rp (IDR, Indonesian Rupiah)
₪ (ILS, Israeli New Shekel)
₩ (KPW, Korean Won)
RM (MYR, Malaysian Ringgit)
$ (MXN, Mexican Peso)
$ (NZD, New Zealand Dollar)
kr (NOK, Norwegian Krone)
Rs (PKR, Pakistan Rupee)
₱ (PHP, Philippine Peso)
zł (PLN, Polish Zloty)
₽ (RUB, Russian Ruble)
$ (SGD, Singapore Dollar)
R (ZAR, South African Rand)
kr (SEK, Swedish Krona)
T$ (TWD, Taiwan Dollar)
฿ (THB, Thai Baht)
t (TRY, Turkish Lira)
₴ (UAH, Ukraine Hryvnia)
Currency
Form field Liability Insurance Amount
requires format 1,000.00
Email Address:
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