Reporting Changes

Service Providers are required to submit a 30-day formal written notice prior to any change in their vendorization.

Changes that require a new vendor number

There are specific changes that will require a new vendor number to be issued such as:

• Changes in Vendor Ownership
• Location
• License or
• Program/Service Design

Title 17 Section 54330 regulations outline the specific changes.

Written notification and the following forms must be updated when other changes occur:

• Contact Sheet, when there is a change in contact information.
• DS 1890 Vendor Application, change in mailing address only.
• DS1891 Vendor Disclosure Statement, for any change in management.
• W9 Form, when bank information or accounting department changes.

Required Renewals

Your vendorization is valid during the effective period of any license, credential, registration, insurance, certificate or permit required, and that vendorization shall not continue if the required documents are suspended or revoked. It is your responsibility to send Harbor Regional Center a copy of any renewals to assure that a current copy is on file. Your vendor file is scanned into a secured program that will place your vendorization on a pending status if any of the required documents are not up to date.

• Insurance Certificate
• Business License 
• Facility License
• Professional License

Report changes and send renewals to: