Exhibit 1 - Vendor Experience Attestation Verification Form.docx

Exhibit 1 Vendor Experience Attestation & Verification Form

Illinois Department of Healthcare and Family Services Genetic Testing Services

2025-55-001/ 26-478HFS-CHSUP-B-49843

This form must be completed in full and submitted with the Vendor’s bid along with documentation demonstrating the minimum five (5) years of experience. This form is for factual verification only to establish responsiveness. Failure to provide a completed form and documentation will result in the bid being deemed non-responsive.

Vendor Name: _______________________________________________ Solicitation Number: _________________________________________

Attestation I attest that the Vendor has a minimum of five (5) years of experience collecting or arranging for the collection of DNA samples by buccal swab and maintaining chain of custody procedures.

Authorized Representative Name: ______________________________ Title: _______________________________________________________ Signature: ___________________________________________________ Date: ________________________________________________________

Experience Verification Summary Provide verifiable information for prior services. Additional rows may be added.

Documentation must allow HFS to verify each contract/project entry; however, a single document may support multiple entries when applicable.

Attach documentation to verify the experience listed above. Acceptable documentation includes:

Contract documents (these may be redacted but will be used to verify experience listed in above table) Purchase orders or invoices showing dates of service

HFS reserves the right to verify the information provided with the contracting entities listed.

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