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CH'U <br />I-FARN, DO. LIV! <br />COVID-19 Vaeeination Requirement Declaration <br />This declaration is required for all suppiiers, vendors and contractors working on-site at a Central <br />Washington University {CWU} location as of October 78,2O21.. The form must be electronically signed <br />using Docu$ign. lf you have questions email to purchasing office@cwu.edu. <br />pursuant to Govcrnor iRslee's Frselarnation 21-14.1 {"Proclamation"}, as amended on August 2$" 2021, <br />and anytirne thereafter, I hereby declare as follows: <br />1. The Ccmpany listed on this form {"Company"} is a contractar with Central Washingtan University <br />{CWU} {"University"} as defined bv the Proclarnation- <br />2. Pursuant to Section 4 of the Proclarnation, Central Washinglon University has elected to require <br />the Company to assume responsibility fsr the vaccination verification and accommodation <br />reguirements included within the Proclar"nation and the Cornpany agrees to assume those <br />responsibilities with respect to all of its employees that provide on-site services to the University. <br />3. The Company has met all of the vaccine verification and accomnnodation requirernents included <br />within the Proclamation. This includes the requirement to obtain a copy or visually observe proof of <br />full vaccination against COVID-19 for every curre*t employae who is subject to the vaccination <br />requirement. <br />4. Any employee of the Company who is not fully vaccinated by October 18,2021, and is not <br />otherwise exempt from the vaccine requirement, will be prohibited from providing on-site services <br />to the University. <br />5. The Company agrees to submit additional signed declaraticns upon the request gf and by the <br />date designated by the lJnive rsity. <br />6. The Company further agrees to cooperate with any investigation or inquiry the University makes <br />into the Company's compliance with the Proclamation. This includes providing informaticn and <br />recorcis upcn request, except any informarion or recorcis ihat ihe eornpany is prohibiied by iaw <br />from disclosing. <br />Gontracts arid PrCIcurement <br />40tl E University Way ' Ellensburg WA 9892S7480 " Office: 509-963-1002 ' Fax: 509-96&2871 <br />Mitchell 2nd Floor Email: purchasing-office@cr,vu-edu' <br />Web; www- cwu.eduieontracts/contracts-purchasing-surplus-home <br />EEO/AA/TITLE lX INSTITUTION " FORACCOMMODATION EMAIL: DS@C\TVU.EDU <br />This is an elec{ronic communicalion from Central Washington Universit-v.