Addendum 1 - Employee healthcare certification final July 2020.pdf

Payment of Employee Health Care Expenses Certification

Under State Finance & Procurement Article Title 17, Subtitle 8

In connection with Solicitation Number BPM020272, 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 health care 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).

[PRIOR TO JULY 1, 2021, THE FOLLOWING OPTION IS ALSO AVAILABLE]

3. ☐ The firm pays some portion of employee health care expenses under a contract with a credible health care insurance plan (as defined above) or through a collective bargaining agreement; and we affirm that our firm will meet the requirements of Option 1 or 2 above upon renewal of the contract or collective bargaining agreement.

4. ☐ The firm has 30 or fewer employees, and 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