Official Government Website

Small Business & Non-Profit Organization
Financial Assistance Supply Request

Quantity
Qty
Item Description
Item
Unit Price
Price
Amount
Total
Disposable Masks - 50 per box
Disposable Masks
50 per box
$35
Cloth Masks - 5 per bag
Cloth Masks
5 per bag
$35
Gloves-Small - 100 pair per unit
Gloves-Small
100 pair per box
$7.25
Gloves-Medium - 100 pair per unit
Gloves-Medium
100 pair per box
$7.25
Gloves-Large - 100 pair per unit
Gloves-Large
100 pair per box
$7.25
Gloves-Extra Large - 100 pair per unit
Gloves-Extra Large
100 pair per box
$7.25
Sanitizer - 1 Gallon
Sanitizer
1 Gallon
$25
Subtotal
Total
  • I am authorized to submit this request on behalf of the entity named above and to accept the terms and conditions of the request on behalf of the entity named above.
  • The information in this request is, to the best of my knowledge, true and correct.
  • If MGS is supplied by the State of Idaho under this request, the MGS will be used only in the conduct of business or services by the entity named above and will not be sold or redistributed to any other party without the written consent of the Department of Administration.
  • The State of Idaho is providing the MGS "as-is" and without warranty of any kind. Except in the case of willful misconduct, the parties intend that the immunity established by Idaho Code section 46-1017 shall apply to the State of Idaho's provision of the MGS. In the event such immunity does not apply, the entity named above waives and releases the State of Idaho from all liability, claims, damages, losses, expenses, actions, settlements, attorneys' fees, and suits whatsoever caused by, arising out of, or in connection with the MGS.

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