• SUPPLY REQUEST
    for
    Personal Protective Equipment &
    Rapid COVID-19 Test Kits

    This portal can be used to order PPE and rapid antigen test kits from the Larimer County Department of Health and Environment (LCDHE). The Department will review each order and can deny, alter, or delay any order without notification. Approved orders are fulfilled during the normal work week (Monday - Friday).


    Supply requests are considered on the basis of urgency (nature of an emergent request), the availability of products, and whether or not the requesting agency has exhausted available options to obtain supplies. Please be advised there is no guarantee on fulfillment of orders or the timeline resources will be allocated.


    The requesting agency must pick-up supplies at a location to be determined once the application has been approved. Supplies cannot be shipped.

    Requesting Agency Must Complete This Form

    (Form posted to: https://www.larimer.gov/health/emergency-preparedness-and-response)

  • ABOUT YOU

    Point-of-Contact
  • Format: (000) 000-0000.

  • Requesting Agency

  • SUPPLY REQUEST

    What type of supplies are you requesting? Please select the items you need and indicate the type/size and quantity where indicated. You can select more than one item.
  • PPE
  • Surgical Mask Type:
  • Disposable Gown Sizes
  • Disposable Nitrile Gloves Sizes

  • PPE
          
             
          
             
          
       
            
             
             
             
             
          
            
                  
             
               
                     
             

    COVID-19 Antigen Test Kits
    (Note: Each kit contains 2 tests)
                         

  • COVID-19 TEST REQUEST

  • SUPPLY QUESTIONS

  • Is this an urgent request for supplies?*
  • Do you have an existing supplier/vendor for the items you are requesting above?*
  • If yes, who is your primary supplier/vendor for these supplies? Select all that apply.*
  • When did you last place an order for these items (with LCDHE or elsewhere)?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you have any pending orders awaiting to be received?*
  • If yes, when is the expected delivery date?*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Point-of-Contact for this facility or organization:
    Name:    *   *   
    Phone:   *   *   
    Email:   *        

  • Should be Empty: