Attachment_O_Payment_of_Employee_Healthcare_Expenses_Certification.pdf
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- Solicitation number
- BPM057754
- Issued by
- Capitol Heights Town, Maryland
About this file
This is a Payment of Employee Healthcare Expenses Certification form required by the State of Maryland under State Finance & Procurement Article Title 17, Subtitle 8, applicable to bidders and subcontractors on state and local contract opportunities. The certification must be completed in connection with solicitation submissions and pertains to employee healthcare coverage requirements for workers assigned to project sites. Bidders must select one of three compliance options: demonstrating that the firm pays aggregate employee healthcare expenses equal to at least 5% of aggregate social security wages paid; pays 50% or more of the required premium for employee coverage under a credible health insurance plan as defined by the state; or qualifies for exemption by maintaining 30 or fewer employees. The form requires the signature, title, and company information of an authorized representative, with the certification effective as of July 2024.
Failure to provide accurate information on this certification subjects the bidder or subcontractor to civil penalties ranging from $2,500 to $25,000 per violation under Maryland Annotated Code Section 17-804. This certification applies to the E-500-261-003 IQC Upgrade Walk-in Refrigerator/Freezers project in Cambridge, Maryland, which is restricted to Small Business Enterprises approved for the Master Contractors Central Region contract. The healthcare expenses certification is a mandatory compliance requirement that must be satisfied prior to bid submission for state and local contract opportunities in Maryland.
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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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