Instructions: Suppliers, contractors and providers complete all sections that are applicable, date and submit.
Please select one:
Check all that apply.
Number of Employees
Please provide the name, address and phone number of two corporations for whom you have provided services in the past 12 months.
A business is considered US Owned if the basic contactual and legal responsibilities for its operation reside within the US, its territories or possessions.
Are one or more of your employees represented by an union?
Is your company equipped for EDI (electronic data integration)?
Please complete this section if you are a certified veteran owned small business (VOSB), minority owned business (MBE), or a woman owned business enterprise (WBE). The intent of the UC Health Supplier Diversity program is to increase the amount of goods and services purchased from certified VOSB, MBE, and WBE vendors.
Please attach the following:
If you are a Certified Diversity vendor, please attach your current certificate from that Certification Agency. Also, please attach either marketing material or a brief description of your business to help us understand your products or services specific to Healthcare.
You may attach up to 3 documents to your application. Attachments may be in Adobe PDF, Microsoft Word, Microsoft Excel, Microsoft Powerpoint, or plain text format only. Each attachment may be no larger than 2MB. Attachments that do not conform to these guidelines will be ignored.
When all sections are complete, press the "Submit Application" button.
Some required information is missing. Please scroll up and enter information in the fields outlined in red.