COVID-19 Procurement Form North Carolina needs companies and manufacturers that can produce and provide critical supplies to respond to the COVID-19 pandemic. If you or your company can sell or donate Personal Protective Equipment (PPE) or other critical supplies to NC, please complete the form below. All required fields must be completed in order to be considered for a procurement. Proof of certifications must be provided for regulated supplies. FDA/CE/NIOSH certifications must be provided without redaction. We understand that manufacturers that have not traditionally made medical supplies and are repurposing their facilities may not have required certifications. If you are a repurposing manufacturer, complete as much information as you can. Brokers must provide written confirmation from the manufacturer confirming supply and delivery, as well as an official quote on letterhead. It is required that you review the PPE Specifications Document prior to completing the COVID-19 Procurement Form. Thank you for supporting North Carolina. Current Acknowledgement PPE Information Complete Indicates required field Please check to acknowledge I have clicked the document link titled "PPE Specifications Document" and reviewed its content. I will provide copies of all required certifications for Personal Protective Equipment (PPE) being offered for sale to the State of North Carolina. Powered Air-Purifying Respirators Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Goggles Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Safety Glasses Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Face Shields Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Nitrile Examination/Medical Gloves Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Nitrile Non-medical Gloves Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Coveralls Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Gowns (Isolation or Surgical) Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Hand Sanitizer Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Disinfecting Spray & Wipes Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Invasive Ventilators Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Other Describe
COVID-19 Procurement Form North Carolina needs companies and manufacturers that can produce and provide critical supplies to respond to the COVID-19 pandemic. If you or your company can sell or donate Personal Protective Equipment (PPE) or other critical supplies to NC, please complete the form below. All required fields must be completed in order to be considered for a procurement. Proof of certifications must be provided for regulated supplies. FDA/CE/NIOSH certifications must be provided without redaction. We understand that manufacturers that have not traditionally made medical supplies and are repurposing their facilities may not have required certifications. If you are a repurposing manufacturer, complete as much information as you can. Brokers must provide written confirmation from the manufacturer confirming supply and delivery, as well as an official quote on letterhead. It is required that you review the PPE Specifications Document prior to completing the COVID-19 Procurement Form. Thank you for supporting North Carolina. Current Acknowledgement PPE Information Complete Indicates required field Please check to acknowledge I have clicked the document link titled "PPE Specifications Document" and reviewed its content. I will provide copies of all required certifications for Personal Protective Equipment (PPE) being offered for sale to the State of North Carolina. Powered Air-Purifying Respirators Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Goggles Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Safety Glasses Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Face Shields Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Nitrile Examination/Medical Gloves Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Nitrile Non-medical Gloves Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Coveralls Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Gowns (Isolation or Surgical) Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Hand Sanitizer Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Disinfecting Spray & Wipes Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Invasive Ventilators Quantity Unit Cost (USD) $ Are you ready to ship? Yes No Estimated lead time to delivery in North Carolina - Select -2 weeks4 weeks6 weeksBeyond 6 weeks Other Describe