Attachment O Payment of Employee Healthcare Expenses Certification.pdf
PDF 180 KB Posted
- Attached to
- CC-622-230-001
- Solicitation number
- BPM057964
- Issued by
- Maryland
About this file
This is an employee healthcare expenses certification form required under Maryland's State Finance & Procurement Article Title 17, Subtitle 8 for the BCCC Life Science Building Restroom Renovation Project (CC-622-230-001). The certification must be completed by bidders and subcontractors to verify compliance with state-mandated employee healthcare expense requirements. The form requires the certifying party to select one of three options demonstrating healthcare coverage provision: paying aggregate employee healthcare expenses of at least 5% of aggregate social security wages, paying 50% or more of required premiums for credible health care insurance plan coverage, or claiming exemption if the firm has 30 or fewer employees.
The certification carries significant legal implications, as false information submitted under this requirement subjects violators to civil penalties ranging from $2,500 to $25,000 per violation under Maryland Annotated Code Section 17-804. The form must be signed by an authorized representative of the bidding firm or subcontractor and include the representative's title, company street address, and city, state, and ZIP code. Completion and submission of this attachment is mandatory for participation in the solicitation process for this Maryland state and local contract opportunity.
View the file
Other files
Show all 23
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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 .