Attachment O Payment of Employee Healthcare Expenses Certification.pdf
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- Attached to
- CC-622-260-003A
- Solicitation number
- BPM059257
- Issued by
- Maryland
About this file
This is an Employee Healthcare Expenses Certification form required under Maryland State Finance & Procurement Article Title 17, Subtitle 8 for Solicitation Number CC-622-260-003A, a Mechanical Replacement project at Life Sciences at Baltimore City Community College. The certification must be completed by the bidder or any subcontractor and submitted in connection with the contract opportunity. The form requires the authorized representative of the firm to certify compliance with employee healthcare expense requirements and acknowledge understanding of applicable penalties for providing false information.
Bidders and subcontractors must demonstrate compliance with 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 employee coverage under a credible health insurance plan as defined in Maryland or elsewhere; or qualifying for exemption if the firm has 30 or fewer employees. Firms providing false certification information are subject to civil penalties ranging from $2,500 to $25,000 per violation under Maryland Annotated Code Section 17-804. The certification requires signature from an authorized representative along with the title, company address, and date of execution.
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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
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