Zimmer Supplier Questionnaire

At Zimmer, Inc., our mission is to develop, produce and globally market the highest-quality orthopaedic products and services that repair, replace and regenerate. Through the hands of skilled surgeons, we will enhance patient quality of life. The Sourcing group constantly seeks to identify and collaborate with Supplier Partners who are willing to align themselves with our mission.

Current Supplier Partners and organizations interested in partnering with Zimmer, Inc., as Suppliers are encouraged to share their backgrounds and capabilities. This information will be held in strict adherence to our privacy policy. The information submitted will be evaluated with respect to current and future needs and requirements of Zimmer, Inc. Therefore, it is important to revisit the site as your capabilities change. Your organization may be considered as a potential candidate for joining Zimmer, Inc., in new projects; however, submission of information in no way guarantees a business relationship with Zimmer, Inc.

Section 1. Supplier Information
Please answer all questions (* indicates required fields).

Company Name: *
Division of: *
Contact Name: *
Street Address: *
P.O. Box: *
City: *
State: *
Province/Region: *
Postal Code: *
Country: *
Phone Number: *
Toll Free:
Fax:
Web Site:

Contacts
Company President:
   Name:
   		 Phone:
 Email:
Sales:
   Name:
   		 Phone:
 Email:
Manufacturing:
   Name:
   		 Phone:
 Email:
Quality:
   Name:
   		 Phone:
 Email:
Customer Service:
   Name:
   		 Phone:
 Email:
Finance:
   Name:
   		 Phone:
 Email:
Purchasing:
   Name:
   		 Phone:
 Email:

What is your Dun & Bradstreet Number?
What is the age of your company in years?
How many years have you been at your current location?
What is the total number of employees at your current location?
What was your annual sales for the fiscal year (dollars)?
What percentage of your last fiscal year sales were to medical/surgical companies? %
What other industries do you serve?
Do you have a 5 year plan? Yes    No
What is your projected growth (percentage) for the next five years? Year 1 %
Year 2 %
Year 3 %
Year 4 %
Year 5 %
Select the type of ownership for your company:

Small Business Administration, Public Law 95-507, Section 211 and FAR 19.7
   Has your company been certified as a SDB by the
   US Small Business Administration?		 Yes    No
   Is your company classified as a SMALL BUSINESS? Yes    No
   Is your company classified as a SMALL DISADVANTAGED BUSINESS? Yes    No
   Is your company classified as a SMALL WOMAN-OWNED BUSINESS? Yes    No
   Is your company classified as a HUBZONE BUSINESS? Yes    No
   Is your company classified as a SERVICE-DISABLED,
    VETERAN-OWNED SMALL BUSINESS?		 Yes    No
   Is your company classified as a VETERAN-OWNED SMALL BUSINESS? Yes    No
   Is your company classified as a LARGE BUSINESS? Yes    No

Have you supplied products to the following Zimmer divisions?
Zimmer, Warsaw Yes    No
Zimmer, Caribe Yes    No
Zimmer, Dover Yes    No
Zimmer, Statesville Yes    No
Zimmer, Japan Yes    No
Zimmer, Swindon Yes    No
Zimmer, Minneapolis Yes    No
Zimmer, Carlsbad Yes    No
Zimmer, Winterthur Yes    No
Zimmer, Austin Yes    No
Is there adjacent land available for expansion? Yes    No
What is the square footage allocated for:
Manufacturing
Storage
Office/Admin
Are you covered by:
Fire Insurance Yes    No Amount (dollars)
Product Liability Insurance Yes    No Amount (dollars)
Workers' Compensation/
Employer's Liability		 Yes    No Amount (dollars)



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