Small Business Safety Improvement Program El Paseo/ S. Solano Application

Small Business Safety Improvement Program Application for the El Paseo & S. Solano MRA

The following form may request personally identifiable or protected health information. Please see our Privacy Policy for details. This form is encrypted. SSL is on to ensure a higher level of security. A human verification system must be completed before submission, you cannot save progress, and you cannot receive an email copy of the form.

*To see the application in another language, use the language drop down at the top of the page*

Eligibility Statement
Applicant must check all boxes that apply:
Eligible Organization Type
Select one of the following choices.
Interested in a one-on-one assessment with the Las Cruces Police Department Community Outreach Unit?(Required)

GENERAL INFORMATION

Please provide the following information
As shown in Line 1 of W-9.
As shown in Line 2 of W-9. (if applicable)
Name(Required)
Principal Business Address
Business Type
Select one of the following choices
Business Start Date
Is your business owned by a socially disadvantaged group (African Americans, Asian-Pacific Americans, Hispanics, Native Americans, Subcontinent Asian Americans, Women)?
How many total full-time equivalent employees does your organization have?
Use the Full-Time Calculator to help you answer this question.

REQUIRED DOCUMENTATION

Applicants are required to submit proof of purchase of eligible equipment and photos of installation of equipment. Once your application has been received, applicants will be required to complete a City of Las Cruces Vendor Packet. Documents can be emailed directly to CLC staff once they have made contact regarding your application.

DISCLAIMER

The City of Las Cruces reserves the right to change the City of Las Cruces Small Business Safety Improvement Program Grant parameters at any time. All information provided is subject to the inspection of Public Records Act (IPRA). For more information, visit https://lascruces.gov/government/city-clerks-office/public-records-request/.

PRIVACY POLICY

A computer communicates with the City of Las Cruces’ website using a particular Internet Protocol address (IP). Like most sites, the City of Las Cruces can track the user’s IP address when visiting the site. The IP address allows the City of Las Cruces to track for each user, information such as the IP address, the browser type, and the identity of the user’s Internet service provider: however, the IP address does not provide any personally identifiable information and allows the user to remain anonymous. This information helps the City to improve site navigation and to make improvements to the City’s website and content. To the extent that the City website contains or may in the future contain online registration forms for special activities or other services, an applicant may be asked during the application process for name, address, e-mail address, phone number, birth date, or other general or special purpose information needed to complete registration for the specific activity or service. To the extent that the City website contains or may in the future contain online volunteer or employment application forms, an applicant may be asked during the application process to provide name, address, e-mail address, phone number, driver’s license number, occupations, work experiences, employment history, education level, and/or references. To the extent that the City website contains or may in the future contain online payment services, the City of Las Cruces will collect personal information, such as name, postal address, e-mail address, and credit card number should you decide to use an online payment service.

APPLICANT CERTIFICATION

The application, including attachments, is subject to disclosure under New Mexico’s public records law, subject to limited applicable exemptions. Applicant acknowledges, understands, and agrees that, except as noted below, all information in its application and attachments will be disclosed without any notice to the applicant if a public records request is made for such information. The City of Las Cruces will not be liable to applicants for such disclosure. Social Security numbers are collected, maintained, and reported by the City of Las Cruces in compliance with IRS 1099 reporting requirements and are not considered public records pursuant to N.M. Sat. Ann _§14-3-7.1. If the applicant believes that information in its application, including attachments, contains information that is confidential and exempt from disclosure, the applicant must include a general description of the information and provide a reference to the New Mexico statute or other law exempting such designated information from disclosure in the event of a public records request. The City of Las Cruces does not warrant or guarantee that information designated by Applicant as exempt from disclosure is exempt and will make disclosure in accordance with applicable law in its sole discretion. For more information about the program, contact 575-528-3475 or [email protected].
Applicant Name(Required)