Attachment_O_Payment_of_Employee_Healthcare_Expenses_Certification.pdf
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- Solicitation number
- BPM059114
- Issued by
- Maryland
About this file
This file is a Payment of Employee Healthcare Expenses Certification form required under Maryland State Finance & Procurement Article Title 17, Subtitle 8, applicable to the AH-000-270-003 IQC Replacement of Gymnasium Bleachers project at Maryland School for the Deaf. The certification must be completed by the bidder or any subcontractor on the project and submitted in connection with the solicitation. The form requires the authorized representative to certify that employees working on or at the project site are covered under one of three qualifying healthcare expense options: aggregate employee healthcare expenses of at least 5% of aggregate social security wages paid; payment of 50% or more of the required premium for employee coverage through a credible health insurance plan as defined in the document; or exemption based on the firm having 30 or fewer employees.
The certification carries significant compliance implications, as false information provided regarding these healthcare requirements subjects the person or entity to civil penalties ranging from $2,500 to $25,000 for each violation under Maryland Annotated Code 17-804. The form requires the signature and date of an authorized representative along with the company's title, street address, and city, state, and ZIP code information. This certification is mandatory for all bidders and subcontractors seeking to participate in this Maryland state and local contract opportunity.
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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 .