26-25569 - Attachment-O.-Payment-of-Employee-Healthcare-Expenses-Certification.pdf
PDF 180 KB Posted
- Attached to
- MEDICAL ADULT DAY CARE PRIVATE PAY SUBSIDY
- Solicitation number
- BPM058856
- Issued by
- Maryland
About this file
This is a certification form for payment of employee healthcare expenses required by the State of Maryland under State Finance & Procurement Article Title 17, Subtitle 8, applicable to bidders and subcontractors on the Medical Adult Day Care Private Pay Subsidy contract (26-25569). The certification requires bidders and subcontractors to demonstrate compliance with Maryland's employee healthcare expense requirements by selecting one of three options: paying aggregate employee healthcare expenses of at least 5% of aggregate social security wages, paying 50% or more of the required premium for credible health insurance coverage, or qualifying for exemption as a firm with 30 or fewer employees.
The certification must be completed and signed by an authorized representative of the bidding or subcontracting firm, with the representative's title, company street address, and city, state, and ZIP code provided. Firms that submit false information regarding this healthcare expense requirement are subject to civil penalties of not less than $2,500 and not exceeding $25,000 per violation under Maryland Annotated Code Section 17-804. The form is effective as of July 2024 and serves as a prerequisite documentation requirement for contract eligibility in Maryland state and local procurement processes.
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Attachment O. Payment of Employee Healthcare Expenses Certification effective date: July 2024
Attachment O. Payment of Employee Healthcare Expenses Certification Under State Finance & Procurement Article Title 17, Subtitle 8
In connection with Solicitation Number _________I, ___________________[Name] hereby certify that ___________________ [Firm Name] is ☐ the bidder/☐ a subcontractor on this project (indicate whether the firm is the bidder or a subcontractor). I further certify that, with respect to employees who will work on or at the site of the project:
[CHOOSE ONLY ONE OPTION BELOW. Note that for purposes of this Certification, “Credible Health Insurance Plan” means any group policy, contract, or program that is written or administered by a disability insurer, health care service plan, fraternal benefits society, self-insured employer plan, or any other entity, in the state of Maryland or elsewhere, that arranges or provides medical, hospital, and surgical coverage not designated to supplement other private or governmental plans.]
1. ☐ The firm pays aggregate employee healthcare expenses of at least 5% of the aggregate social security wages paid.
OR
2. ☐ The firm pays 50% or more of the required premium necessary to obtain employee coverage by a credible health care insurance plan (as defined above).
OR
3. ☐ The firm has 30 or fewer employees and is therefore exempt.
Further, I acknowledge that under §17-804 of the State Finance and Procurement Article, Maryland Annotated Code, a person or entity providing false information regarding this requirement may be subject to a civil penalty of not less than $2,500 and not exceeding $25,000 for each violation.
Signature of Authorized Representative Date
Title of Authorized Representative
Company Street Address
City, State, ZIP Code
File details come from the government source that posted it. Updated .