Los Angeles County Department of Public Health COVID-19 Vaccine Related Donations
If you have goods or services to donate to our COVID-19 vaccination efforts, please complete the form below. A representative from the Department of Public Health will contact you to discuss your donation offer. Serious inquiries only please.
* Required
Name
*
Your answer
Company
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Website URL
Your answer
Location (Address, City, State, ZIP)
Your answer
Type of Donation
Space/site for vaccine dispending
Supplies for vaccine administration
Food
Transportation
Storage/Facilities
PPE/Healthcare Equipment
Other:
Please describe the donation including amount of capacity.
Your answer
Can you deliver the donation, if applicable?
Yes
No
Clear selection
Is there any cost for or associated with the donation?
Yes
No
Clear selection
Please provide any details related to the cost of the donation, if applicable.
Your answer
Is the donation worth more than $10,000?
Yes
No
Clear selection
What is the earliest date and time you could provide the donation?
MM
/
DD
/
YYYY
Please briefly describe your company/organization.
Your answer
Do you/your organization have experience providing vaccinations or disaster relief?
Yes
No
Clear selection
Do you currently do business with Los Angeles County?
Yes
No
Clear selection
If yes, please describe.
Your answer
Please provide your Los Angeles County Vendor Number, if applicable.
Your answer
Please provide any additional information regarding the donation that was not included above.
Your answer
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