Form LIC 9141. Vendor Application/Renewal - Administrator Certification Program - California

Form LIC 9141 is used for the application or renewal of vendor status in California's Administrator Certification Program. This form is completed by vendors who provide goods or services to individuals seeking administrator certification in facilities regulated by the California Department of Social Services.

The form consists of sections that require the vendor's contact information, a description of the goods or services provided, and any relevant supporting documentation. Important fields include information about the vendor's business, the specific goods or services offered, and any necessary documentation to demonstrate compliance with program requirements. It is essential for vendors to accurately provide all requested information and ensure that they meet the qualifications and standards set by the California Department of Social Services.

An application example of this form would involve a vendor completing Form LIC 9141 to apply for or renew their vendor status in the Administrator Certification Program. The vendor would provide their contact information, describe the goods or services they offer, and submit any required supporting documents, such as licenses or certifications. By successfully completing this form, the vendor can establish or maintain their approved vendor status and continue providing goods or services to administrators seeking certification in compliance with state regulations.