Payment of Employee Health Care Expenses Certification.pdf
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- Solicitation number
- BPM025075
- Issued by
- Maryland
About this file
This document is a Payment of Employee Health Care Expenses Certification form required for a state and local contract opportunity in the state of Maryland. The contract opportunity is for the Kitzmiller and Vindex Doser Painting Project, which involves sandblasting and painting two lime dosers, their associated silos, and metal enclosures. The certification form requires the bidder or subcontractor to affirm that they either pay at least 5% of their employees' aggregate social security wages towards healthcare expenses, or they pay at least 50% of the premium necessary to provide employees with credible health insurance coverage. Alternatively, the firm can certify that they pay some portion of employee healthcare expenses through a collective bargaining agreement or contract with a credible health insurance plan, and they will meet the 5% or 50% requirement upon renewal of the agreement or contract. Firms with 30 or fewer employees are exempt from this requirement. Providing false information on this certification may result in civil penalties ranging from $2,500 to $25,000 per violation.
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Text version
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 .