DMC.org Vendor Services Homepage Contacts

Detroit Medical Center
Vendor Services

View RFPs

Contacts

Supplier Diversity Program Information

Vendor Section Homepage
DMC Vendor Policies and Compliance Program

MMBDC Corporation of the Year Award - Healthcare Category, 1997, 1999, 2000, 2001, 2002

MMBDC Corporate One Award - 1999, 2000, 2001, 2002

MMBDC Minority Input Committee Healthcare Sector 2002

Mich Hispanic Chamber of Commerce-Corporation of the Year Award - Non-Automotive Category, 2001

Vendor Services

VENDOR/SUPPLIER DISCLOSURE FORM

Click here for a downloadable version of the Vendor/Supplier Disclosure form in PDF format.

The above named vendor/supplier hereby declares that they have not provided gifts, entertainment or other gratuities to any Detroit Medical Center (DMC) employee, medical staff, students, volunteers and contractors.

The above named vendor/supplier further declares that it shall not affect the DMC's purchase decision-making process by offering any of the services/items listed below to any DMC employee, medical staff, student, volunteer and/or contractor [list not all inclusive or all encompassing]:
HAVE YOU, AS A VENDOR/SUPPLIER OR REPRESENTATIVE, PROVIDED ONE OR MORE OF THE ITEMS LISTED BELOW IN THE PAST TO ANYONE WITHIN DMC? IF SO,PLEASE INDICATE YOUR ANSWER BY CHECKING A BOX BELOW.
1) Clinical Trials 8) Personal Use Direct Purchases
2) Discounts 9) Political Contributions
3) Education/Seminars/Conferences 10) Promotions/Contests
4) Gifts 11) Property
5) Honoria 12) Samples and/or Free Goods
6) Meals and Entertainment 13) Services
7) Outside Employment 14) Travel and/or Lodging
Yes, I have provided one of the above listed items to persons at the DMC.
I am disclosing the details of the gift, payment of favor provided to the DMC employee, and name the employee(s) in the space below.
No
Are there additional disclosures of transactions and interest which may relate to an actual or perceived conflict of interest with the DMC? If yes, please provide details below.
Yes
No

The vendor's signature below indicates the following :
1) The information provided on this form is accurate;
2) The vendor understands that there is a continuous obligation to update the
      information on this form; and
3) The organization will continue to conduct its business with the DMC in
      accordance with the vendor disclosure rules included in the DMC Ethics and
      Business Conduct Policy and with the DMC Code of Conduct.

 

 
Date  : 
  (Date format: MM/DD/YYYY)


Copyright® 1998- Detroit Medical Center
The trademarks used or referred to on this Site are the exclusive property of the Detroit Medical Center ("DMC") and may not be used in any way without written consent of the DMC.
Site by CareTech Solutions Inc., Administrator Login