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COVID-19 Rapid Response Procurement Information Form

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* 1. Company name

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* 2. Contact name

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* 3. Contact Email

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* 4. Product(s)

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* 5. Current Production Capacity - Units/Week

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* 6. Current Unit Price $

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* 7. Product Availability based on current capacity

Date

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* 8. Proposed Production Capacity Units/Week

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* 9. Proposed Unit Price $ (covering costs of scale-up)

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* 10. Product Availability based on Proposed Capacity

Date

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* 11. Is this in current production?

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* 12. If no, proposed production method

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* 13. Is further product development required?

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* 14. Has the Product been approved by Health Canada, or regulatory authority

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* 15. If no, expected date of certification or plan

Date

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* 16. Does your company have the appropriate regulatory and product certifications?

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* 17. If no, expected date or plan

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* 18. Do you have the appropriate testing capabilities and approvals?

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* 19. If no, expected date or plan

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* 20. Do you have an existing distribution channel to deliver your product(s) to market?

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* 21. If no, expected date or plan.

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* 22. Do you have an existing Purchase Order for your product line?

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* 23. If no, are you in discussions regarding a Purchase Order?

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* 24. If Yes, please identify with whom and expected timeline.

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