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Forms for USC Suppliers

The following are forms required for specific types of suppliers and/or purchases.

Construction, Maintenance, and Facilities Forms

To apply for a prequalified construction, maintenance, or facilities contractor status, complete the following per the instructions on the forms:

Contractor Prequalification Application (word)
Construction Project Experience Form (web form; click Done to generate a printable pdf) Attach three to five forms to the Contractor Prequalification Application
Internal Requisition Form

Large Supplier Forms (Suppliers with contracts or POs larger than $30K)

Debarment Form (pdf) For purchases $30K or more
Certificate of Non-Discrimination (pdf) For purchases $100K or more
Lobbying and Anti-Kickback Certification (pdf) For purchases $100K or more

Services to Healthcare Units Forms

Consulting firms and/or individuals providing services to Keck Medicine of USC, the Herman Ostrow School of Dentistry, the USC School of Pharmacy and the University Park Health Center are required to complete and submit the following forms:

Business Associate/Privacy and Security Addendum (pdf) Must be on file with the university prior to doing business
Services to Healthcare Units Requirements (word - February 29, 2012) Must accompany all Professional Services Agreements (PSA), Independent Contractor Agreements (ICA), and Payment Request for Limited Engagement of Individuals (LEI)

It is recommended that a copy of these forms be retained by the firm/individual to be used for future engagements.