COVID_19_Vaccine_Policy_Attestation.docx
DOCX document 56 KB Posted
- Solicitation number
- 12300125A
- Issued by
- Los Angeles County, San Francisco City, California
About this file
The document is a COVID-19 Vaccine Policy Attestation for contractors working with the City of Santa Monica, California. The attestation requires all contractor personnel and subcontractors who will visit City facilities or interact with City employees or residents to be fully vaccinated according to the City's COVID-19 Vaccination Policy. Contractors must maintain documentation proving full vaccination of their personnel and be prepared to provide this documentation for inspection upon the City's request within 10 days.
The attestation serves as a compliance document for City contracts, with serious consequences for non-compliance, including potential termination of the agreement. Contractors must obtain written authorization from personnel before submitting vaccination documentation and must demonstrate understanding of the vaccination policy. The document includes provisions for the contractor's authorized representative to sign, date, and provide contact information, affirming their comprehension and commitment to the vaccination requirements.
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Text version
THIS COVID-19 ATTESTATION MUST BE EXECUTED &
SUBMITTED TO CITY AND MADE PART OF AGREEMENT NO. ______.
Contractor attests that all of Contractor’s personnel and subcontractors assigned to perform the Services who will either visit or work in City of Santa Monica facilities, or interact with either City of Santa Monica employees or residents, in the course of performing said Services shall be fully vaccinated as defined in the City’s COVID-19 Vaccination Policy (“VP”), a copy of which is attached as Exhibit ___ to the Agreement under which Contractor, Contractor’s personnel, and/or subcontractors will perform the Services.
Contractor further attests that such personnel and subcontractors have produced to Contractor one of the forms of documentation set forth in the VP. Contractor shall maintain the underlying documentation establishing that such personnel and subcontractors are fully vaccinated and supporting the attestation for the term of the Agreement. Contractor agrees that Contractor will make such documentation available to the City for inspection on demand. Contractor agrees that it will obtain written authorizations from personnel and subcontractors prior to submitting the documentation to City.
Contractor further understands and agrees that failure to comply with the VP, or to permit the City to inspect the documentation to verify compliance with the VP within 10 days after the City’s written request for such documentation, shall constitute a breach of the Agreement and will be grounds for termination.
The undersigned, on behalf of himself or herself individually and on behalf of Contractor, hereby attests that he or she has read and understands the VP and its applicability to the Agreement. The undersigned further attests that he or she is authorized to execute this attestation on behalf of Contractor.
Prepared by: ____________________________Title: ________________________ Signature: ______________________________________ Date: _______________ Email: ____________________________________ Phone: ____________________ image1.jpeg
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