Application Guidance - Section 6 Qualifying Questions

Eligibility to be a WIC Authorized Vendor will be determined based on the responses below, and the Application may be denied if any eligibility criteria are not met.

You must respond truthfully and accurately to each of the 14 questions. Your response will be used to determine whether you meet the eligibility criteria for a WIC vendor.

If your response determines that you do not meet eligibility criteria, you will be notified immediately within the application.

Questions

  1. Is the vendor located in the state of Illinois? Yes No
  2. Is the fixed and permanent location the same as the address provided on page one of the application, and will this be the address where WIC Cardholders will select foods during business hours?
  3. Are 70% or more of the vendor's gross annual receipts from selling non-alcoholic products?
  4. Will the percentage of sales revenue from food purchased with WIC Benefits be less than 50% of total SNAP-eligible food sales?
  5. Have any owners, officers, or officials of the Vendor entity been involved in bribery as prohibited under Section 50-5 of the Illinois Procurement Code?
  6. Have any owners, officers, or officials of the Vendor entity been barred from receiving state contracts due to any default on any education loans as the term is defined in the Educational Loan Default Act [5 ILCS 385]? If yes, provide their name(s), and details in a separate attachment.
  7. Do or will any owners, officers, officials of the Vendor entity, or any spouses or minor children of any owners, officers, or officials hold an elective office in the State of Illinois, a seat in the General Assembly, or any appointment or employment in any of the offices of State government? If yes, provide name(s), relations(s), and office(s), appointment(s) or position(s) held in a separate attachment.
  8. Are any of the owners, officers, officials of the vendor entity, or any spouses or minor children who own more than 7.5% ownership or beneficial interest in the business employed by the WIC Program of a local agency? If yes, provide name(s), relations(s), and place of employment in a separate attachment.
  9. Have any owners, officers, or officials of the Vendor entity been convicted of a misdemeanor involving fraud, misuse, or theft of State or federal funds or any felony? If yes, provide name(s), date(s) of convictions, and type(s) of crime in a separate attachment.
  10. Have any vendor entity owners, officers, or officials been barred from bidding on or entering into a WIC Vendor contract due to a violation of Sections 33E-3 or 33E-4 of the Criminal Code of 2012? If yes, provide details in a separate attachment, including name(s) and the date(s) of violation.
  11. Have any owners, officers, or officials of the vendor entity who hold 30% or more ownership been terminated from the WIC Program in the previous 3 years? If yes, provide the details, including name(s), dates(s) of termination, and the store involved in a separate attachment.
  12. Do all vendor entity owners, officers, and officials agree to adhere to the provisions of the USDA WIC Regulations, the Act, the WIC Vendor Administrative Code, the EBT Operating Rules, and, once authorized, the WIC Vendor Contract?
  13. Does the vendor agree to maintain minimum quantities, sizes, and types of WIC Foods necessary as provided at the time of application based on a peer group assignment?
  14. As a vendor with a Pharmacy, do you commit to providing and selling all WIC Authorized special formulas in at least one flavor in the quantity prescribed or requested within two (2) business days upon request?