County of San Diego COVID-19 Response - Personal Protective Equipment (PPE), Medical Supplies and Services Information Form Survey

Thank you for your interest in supporting the County of San Diego's COVID-19 response. If you have Personal Protective Equipment (PPE), medical supplies (including those for testing and vaccination), or related services that can be made available to the County, please provide the information requested below. Should the County have a need for or questions regarding your supplies or services, the County will contact you.

Please note that all purchases made by the County will be in compliance with any applicable federal, State and local laws and regulations, including California Penal Code Title 10 (link).

If you would like to provide hotel/motel rooms, full service vaccination sites/pods, or vaccination clinical staffing, please see the links below for the correct survey/form:

Hotel/Motel Rooms: https://www.surveymonkey.com/r/PLK6DLH

Vaccination Site/Pod and Clinical Staffing: https://www.surveymonkey.com/r/VNPQXZW

1.Contact Information(Required.)

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

2.Website Address(Required.)

3.Type of Personal Protective Equipment (PPE), supplies or services. If you are offering more than one category, please submit a separate form for each.(Required.)

4.Product or Service Description (common product or model name)(Required.)

5.Please describe your unit of measure (eg. case, box, bottle, etc.)(Required.)

6.Is there a minimum or maximum order quantity?(Required.)

Yes

7.If you answered yes to the question above, please describe

8.What is the price per unit?(Required.)

9.Attach a product specification or description of services(Required.)

No file chosen

Current Progress,

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