New Jersey COVID-19 Supplier Registry

This COVID-19 Supplier Registration Form is a tool developed by the New Jersey Economic Development Authority (NJEDA) to create a registry of potential suppliers of critical PPE, medical devices (e.g., ventilators) and other high-demand raw materials.
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Primary Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Organization Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide an answer in years.

Are you currently registered in the NJ Start System? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What are your typical payment terms? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Identify Verification

Filling out this section is not required, but it will help our team vet your organization and your offer

Has your organization previously done business with the State of New Jersey? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has your organization previously done business with the Federal Governemnt through the US General Services Administration (GSA)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has your organization previously done business with another U.S. state? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Designations

Please indicate below whether your company self-identifies and/or is registered with the State of New Jersey (Division of Revenue and Enterprise Services, Small Business Registration and M/WBE Certification Services Unit) as one or more of the business types/categories listed below:

Small Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Women-Owned Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Minority-Owned Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Veteran-Owned Business, N.J.S.A. 52:32-49, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Disabled Veteran-Owned Business N.J.S.A. 52:32-31.1, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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NOTE:

Entries into this registry may be vetted by members of State government agencies, healthcare system entities, or other local government entities. This vetting may include examining valid business registration, tax clearance, debarment, and other basic business validity checks.

The purpose of this form is to create a registry. This is NOT an official State of New Jersey procurement document and in no way indicates an offer to purchase products or materials. NJEDA will not undertake procurements for these products or materials.

Information provided to the NJEDA using this tool may be shared with healthcare, supply chain, or government entities within New Jersey (and in other regions) to support the response to the COVID-19 public health crisis. Registrants may be contacted if they can fill an urgent supplier need.

Products

Product {binding ItemNumber}

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Has this product been approved by a standards or certification body? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Can you provide evidence that the product is manufactured in an FDA registered facility? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What is the unit size that you are selling in? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Model numbers, additional size information such as for children or infrants, FDA approval, etc.

Sizes

Size
Units Available
Price per Unit
Item {binding ItemNumber}
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Are you the manufacturer of this product or a supplier? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Have you made or sold this particular product before, or is this a new line of business for your organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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New Jersey COVID-19 Supplier Registry

New Jersey COVID-19 Supplier Registry

This COVID-19 Supplier Registration Form is a tool developed by the New Jersey Economic Development Authority (NJEDA) to create a registry of potential suppliers of critical PPE, medical devices (e.g., ventilators) and other high-demand raw materials.
Primary Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Primary Contact Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Organization Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Primary Contact Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Registered Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Doing Business As (DBA) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Employer Identification Number (EIN) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Organization Website {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Organization Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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How long has organization been in business? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Are you currently registered in the NJ Start System? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
What are your typical payment terms? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Identify Verification

Has your organization previously done business with the State of New Jersey? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please provide a past State of New Jersey purchase order number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please provide your State of New Jersey vendor number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Has your organization previously done business with the Federal Governemnt through the US General Services Administration (GSA)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide a past GSA contract number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Please provide your DUNS number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has your organization previously done business with another U.S. state? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Please indicate which state {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide a purchase order number from that state {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Designations

Small Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Women-Owned Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Minority-Owned Business, N.J.S.A. 52:32-17, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Veteran-Owned Business, N.J.S.A. 52:32-49, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Disabled Veteran-Owned Business N.J.S.A. 52:32-31.1, et seq. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

NOTE:

Entries into this registry may be vetted by members of State government agencies, healthcare system entities, or other local government entities. This vetting may include examining valid business registration, tax clearance, debarment, and other basic business validity checks.

The purpose of this form is to create a registry. This is NOT an official State of New Jersey procurement document and in no way indicates an offer to purchase products or materials. NJEDA will not undertake procurements for these products or materials.

Information provided to the NJEDA using this tool may be shared with healthcare, supply chain, or government entities within New Jersey (and in other regions) to support the response to the COVID-19 public health crisis. Registrants may be contacted if they can fill an urgent supplier need.

Products

Product {binding ItemNumber}

Resource Group {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Resource Category {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Has this product been approved by a standards or certification body? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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What standards or certifications does the product have? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Can you provide evidence that the product is manufactured in an FDA registered facility? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What is the brand of the product? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What is the unit size that you are selling in? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide any additional description of the product necessary. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Sizes

Size
Units Available
Price per Unit
Item {binding ItemNumber}
Size {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Units Available {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Price per Unit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Are you the manufacturer of this product or a supplier? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you made or sold this particular product before, or is this a new line of business for your organization? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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How many days until you can deliver the product to New Jersey? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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What is your weekly production/supply capacity? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Is there any additional information you would like to provide about this product or opportunity? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please upload any certifications (FDA, CE, etc) and any product testing reports and spec sheets. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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