Payment of Employee Health Care Expenses Certification.docx
DOCX document 22 KB Posted
- Solicitation number
- BPM038361
- Issued by
- Anne Arundel County, Annapolis City, Maryland
About this file
This document is a Payment of Employee Health Care Expenses Certification form related to a state and local contract opportunity in Maryland. The form requires the bidder or subcontractor to certify that they either pay at least 5% of the aggregate social security wages towards employee health care expenses or pay 50% or more of the required premium for employee health care coverage through a credible health insurance plan. Prior to July 1, 2021, the firm could also certify that they pay some portion of employee health care expenses under a contract or collective bargaining agreement and affirm they will meet the 5% or 50% requirements upon renewal. Firms with 30 or fewer employees are exempt from this requirement. Failure to provide accurate information may result in civil penalties.
The related state and local contract opportunity is for the B-450-210-001 Gold Star Family Memorial Infrastructure Improvement project in Annapolis, Maryland, which involves Anne Arundel County and the City of Annapolis. No other details about the scope, timeline, or procurement process are provided in the given information.
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Payment of Employee Health Care 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 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
File details come from the government source that posted it. Updated .