Revised June 5 2026 Attachment A VENDOR QUALIFICATIONS CERTIFICATION -.docx
DOCX document 47 KB Posted
- Contract number
- 26-478HFS-DIREC-P-100589
- Issued by
- Illinois
About this file
This is a Vendor Qualifications Certification attachment for a state and local contract award issued by an unnamed state agency's Health and Family Services department for Communications and Advertising Services related to Medicaid Outreach. The contract is designated as Agency Contract Number 2026-00-025 and references procurement number 26-478HFS-DIREC-B-51797. The document establishes mandatory vendor qualification requirements that must be met for bid responsiveness in the competitive solicitation process.
The certification requires vendors to demonstrate five consecutive years of continuous operation in communications and advertising services, either under their current legal entity or a legally continuous predecessor. Vendors must document at least three qualifying public sector or government campaigns that include paid media planning and placement services and plain-language or accessibility components. All listed campaigns must have been performed by the bidding vendor as the prime contractor, excluding campaigns based solely on individual employee prior experience at other firms or subcontractor work, unless performed by a legally continuous predecessor entity. The vendor must certify under penalty of non-responsiveness that all submitted information is accurate and complete. The document requires authorized signatory certification but contains no pricing information, set-asides, option periods, or contract amounts, functioning instead as a qualification screening mechanism for proposal evaluation.
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Text version
Revised June 5, 2006
COMMUNICATIONS AND ADVERTISING SERVICES FOR MEDICAID OUTREACH
VENDOR QUALIFICATIONS CERTIFICATION
ATTACHMENT A
26-478HFS-DIREC-B-51797
AGENCY CONTRACT NUMBER: 2026-00-025
(FACT-PASS / RESPONSIVENESS ONLY)
SECTION A – VENDOR IDENTIFICATION (FACTUAL - Section 1.5.1 and 1.5.3 and any other applicable provisions of this Contract relating to these requirements) Vendor Legal Name: ______________________________ Year Entity Was Established (MM/YYYY): ______________________________
SECTION B – CONTINUOUS OPERATION (PASS / FAIL REQUIREMENT - Section 1.5.1 and 1.5.3 and any other applicable provisions of this Contract relating to these requirements) Check one box only:
☐ The Vendor has been in continuous operation providing communications and advertising services for at least five (5) consecutive years immediately preceding the Bid opening date , either under its current legal entity or a legally continuous predecessor entity.
☐ The Vendor does not meet this requirement.
If the Vendor has had a legal name change or legal reorganization during the five-year period, list only factual details below (no narrative):
· Former legal name(s): ______________________________
· Effective date(s) of change: ______________________________
SECTION C – PUBLIC SECTOR CAMPAIGN EXPERIENCE
(PASS / FAIL REQUIREMENT – Section 1.5.4 and 1.5.6 and any other applicable provisions of this Contract relating to these requirements) The Vendor must list at least three (3) qualifying campaigns.
Each listed campaign must meet all three criteria identified in Section D below to count.
Campaign Experience Table (FACTUAL ONLY) Limit each entry to brief factual information to identify the campaign
Public Sector Or Government Client (Name)
Entity Type Campaign Start Date
(MM/YYYY)
| Campaign End Date (MM/YYYY) |
| Geographic Scope (check one) |
| Paid Media Planning & Placement (Yes/No) |
| Plain-Language / Accessibility (Yes/No) |
☐ Federal ☐ State ☐ Local ☐ County ☐ Municipal ☐ Regional Auth.
☐ Public Health
☐ Statewide ☐Multi-Regional ☐ Yes ☐ No ☐ Yes ☐ No
☐ Federal ☐ State ☐ Local ☐ County ☐ Municipal
☐ Statewide
☐ Yes ☐ No ☐ Yes ☐ No
☐ Federal ☐ State ☐ Local ☐ County ☐ Municipal
☐ Statewide
☐ Yes ☐ No ☐ Yes ☐ No
SECTION D – PRIME CONTRACTOR & ENTITY-LEVEL CERTIFICATION
(FACT-PASS - Section 1.5.4 and 1.5.6 and any other applicable provisions of this Contract relating to these requirements) Check all boxes to be responsive:
☐ All campaigns listed in Section C were performed by the bidding Vendor entity as the prime contractor.
☐ No campaign listed is based solely on the prior work history of individual employees while employed by another firm.
☐ No campaign listed is based solely on subcontractor, affiliate, or parent-entity experience unless performed by a legally continuous predecessor entity of the Vendor.
SECTION E – CERTIFICATION AND ACKNOWLEDGMENT
By signing below, the Vendor certifies and attests that:
1. All information provided in this Attachment A is true, accurate, and complete;
2. The requirements addressed herein are mandatory responsiveness requirements of the IFB;
3. The Agency will make a pass/fail determination based on the information submitted and factual verification using publicly available or other reliable sources; and
4. Failure to meet any requirement or submission of false or misleading information shall render the bid non-responsive.
Authorized Signatory Name: ______________________________ Title: ______________________________ Signature: ______________________________ Date: ______________________________ Top of Form Bottom of Form image1.png
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