U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

CERTIFICATION OF ANNUAL
ACCOUNTING STATEMENT
(Carrier)

This is to certify that I have reviewed this accounting statement and to the best of my knowledge and belief:

1. The statement was prepared in conformity with guidelines issued by the Office of Personnel Management and fairly presents the financial results of this reporting period in conformity with those guidelines;

2. The costs included in the statement are actual, allowable, allocable and reasonable in accordance with the terms of the contract and with the cost principles of the Federal Employees Health Benefits Acquisition Regulation and the Federal Acquisition Regulation;

3. Income, rebates, allowances, refunds and other credits made or owed in accordance with the terms of the contract and applicable cost principles have been included in the statement;

4. If applicable, the letter of credit account was managed in accordance with 5 CFR part 890, 48 CFR chapter 16, and OPM guidelines.

CARRIER NAME______________________________________________________

CERTIFICATION OF ANNUAL

ACCOUNTING STATEMENT

(Underwriter)

This is to certify that I have reviewed this accounting statement and to the best of my knowledge and belief:

1. The statement was prepared in conformity with guidelines issued by the Office of Personnel Management and fairly presents the financial results of this reporting period in conformity with those guidelines;

2. The costs included in the statement are actual, allowable, allocable and reasonable in accordance with the terms of the contract and with the cost principles of the Federal Employees Health Benefits Acquisition Regulation and the Federal Acquisition Regulation;

3. Income, rebates, allowances, refunds and other credits made or owed in accordance with the terms of the contract and applicable cost principles have been included in the statement;

4. If applicable, the letter of credit account was managed in accordance with 5 CFR part 890, 48 CFR chapter 16, and OPM guidelines.

CARRIER NAME___________________________________________

__________________________________________________________
NAME AND TITLE OF RESPONSIBLE CORPORATE OFFICIAL
(TYPE OR PRINT)

__________________________________________________________
SIGNATURE OF RESPONSIBLE CORPORATE OFFICAL

_________________________
DATE SIGNED

Download this Letter as a PDF File
Back to Carrier Letter