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EXHIBIT D, DOH CONTRACT GVL26649-0 <br />DEPARTMENT OF HEALTH <br />Contractor/Vendor Certification <br />Proclamation 21-14 - COVID-19 Vaccination Certification <br />KITTITAS COUNTY HEALTH DEPARTMENT <br /> <br />DOH Contract GVL26649-0 Page 26 of 27 <br />Revision October 2021 <br />To reduce the spread of COVID-19, Washington state Governor Jay Inslee, pursuant to emergency powers <br />authorized in RCW 43.06.220, issued Proclamation 21-14 – COVID-19 Vaccination Requirement (dated <br />August 9, 2021), as amended by Proclamation 21-14.2 – COVID-19 Vaccination Requirement (dated <br />September 27, 2021) and as may be amended thereafter. The Proclamation requires contractors/vendors <br />who have goods, services, or public works contracts with a Washington state agency to ensure that their <br />personnel (including subcontractors) who perform contract activities on-site comply with the COVID-19 <br />vaccination requirements, unless exempted as prescribed by the Proclamation. <br /> <br />I hereby certify, on behalf of the firm identified below, as follows <br /> CONTRACTOR/VENDOR {{*plan_es_:signer1:dropdown(options=”has, does not have”)}} <br />A COVID-19 CONTRACTOR VACCINATION VERIFICATION PLAN THAT COMPLIES WITH THE <br />VACCINATION PROCLAMATION. <br /> <br /> Explanation/Information/Definition <br />CONTRACTOR/VENDOR HAS A COVID-19 CONTRACTOR VACCINATION VERIFICATION <br />PLAN THAT COMPLIES WITH THE VACCINATION PROCLAMATION. Contractor/Vendor: <br />1. Has reviewed and understands Contractor/Vendor’s obligations as <br />set forth in Proclamation 21-14 – COVID-19 Vaccination <br />Requirement (dated August 9, 2021), as amended by Proclamation <br />21-14.2 – COVID-19 Vaccination Requirement (dated September <br />27, 2021); <br />2. Has developed a COVID-19 Vaccination Verification Plan for <br />Contractor/Vendor’s personnel (including subcontractors) that <br />complies with the above-referenced Proclamation; <br />3. Has obtained a copy or visually observed proof of full vaccination <br />against COVID-19 for Contractor/Vendor personnel (including <br />subcontractors) who are subject to the vaccination requirement in <br />the above-referenced Proclamation; <br />4. Complies with the requirements for granting disability and religious <br />accommodations for Contractor/Vendor personnel (including <br />subcontractors) who are subject to the vaccination requirement in <br />the above-referenced Proclamation; <br />5. Has operational procedures in place to ensure that any contract <br />activities that occur in-person and on-site at Department of Health <br />premises that are performed by Contractor personnel (including <br />subcontractors) will be performed by personnel who are fully <br />vaccinated or properly exempted. <br />6. Has operational procedures in place to enable Contractor/Vendor <br />personnel (including subcontractors) who perform contract activities <br />on-site at Department of Health premises to provide compliance <br />documentation that such personnel are in compliance with the <br />above-referenced Proclamation; <br />7. Will provide to Agency, upon request, Contractor/Vendor’s <br />COVID-19 Vaccination Verification Plan and related records, <br />except as prohibited by law, and will cooperate with any <br />investigation or inquiry pertaining to the same.