L.A. Care Health Plan Vendor Diversity Intake Form

Thank you for your interest in vendor diversity at L.A. Care Health Plan. If you are a diverse vendor certified by a third party agency, please complete the form below to share your company’s information.

Please make sure to complete all required fields marked with an asterisk (*).
 

Company Information

Providing your Tax ID helps to distinguish your company from another company with the same or similar name.

 

Contact Information

 

Vendor Diversity Classification Information

 

Certifying Agency

Please indicate the third party agency from which your company has been certified as a Disabled Veteran Business Enterprise (DVBE), Small Business Enterprise (SBE) or Social Enterprise (SE), and attach a copy of your certification below. If you are third party certified in more than one diversity classifications, please list all.


Attachments

L.A. Care Health Plan requires vendors who classify as a Disabled Veteran Business Enterprise (DVBE), Small Business Enterprise (SBE) or Social Enterprise (SE) to obtain certification through a third party agency. Please upload certification documents including unexpired certification from a recognized certifying agency.

More information

  • Files must be less than 25 MB.
  • Allowed file types: pdf doc docx xls xlsx.

More information

  • Files must be less than 25 MB.
  • Allowed file types: pdf doc docx xls xlsx.

More information

  • Files must be less than 25 MB.
  • Allowed file types: pdf doc docx xls xlsx.

Please note that L.A. Care’s procurement practices are based on a competitive process. Your submission of this form is not a guarantee of any business opportunity, does not automatically qualify your company as an L.A. Care approved vendor, and does not obligate L.A. Care to solicit requests for proposals/quotations/information.