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Home My WebLink AboutBack-Up DocumentsRon DeSantis Governor ■ ■ Barbara Palmer Director ■ ■ State Office 4030 Esplanade Way Suite 380 Tallahassee, FL 32399-n°n ■ ■ Northwest Region 4030 Esplanade Way Suite 280 Tallahassee, FL 32399-2949 ■ ■ Northeast Region 3631 Hodges Boulevard Jacksonville, FL 32224 ■ ■ Central Region 400 West Robinson Street Suite S430 Orlando, FL 32801 ■ ■ Suncoast Region 1313 North Tampa Street Suite 515 Tampa, FL 33602 ■ ■ Southeast Region 111 South Sapodilla Avenue Suite 204 West Palm Beach, FL 33401 ■ ■ Southern Region 401 NW 2nd Avenue Suite South 811 Miami, FL 33128 agency for persons with disabilities State of Florida Tuesday, March 16, 2021 CITY OF MIAMI C/O ADINE M. SADIN 4560 NW 4TH TER MIAMI Florida, 33126 Provider # 024990496 MWSA Renewal 1st Notice Dear: ADINE M. SADIN This letter is to notify you that your Medicaid Waiver Services Agreement (MWSA) with the Agency for Persons with Disabilities (APD) Developmental Disabilities Waiver Program (DDWP) is going to expire on June 30, 2021. In order to continue to receive payment for services rendered through the DDWP, you must submit the documents listed below within 30 calendar days from the date of this letter. Documents to be submitted: ■ Signed Medicaid Waiver Service Agreement ■ Declaration Page of General/Professional Liability Insurance Must list APD as a Certificate Holder ■ Level II Background Screening APD General "line item" with an eligible status in the Agency for Healthcare Administration {AHCA) Care Provider Background Screening Clearinghouse ■ Local Criminal Records Check Obtained through local law enforcement agencies ■ Copy of professional license or certificate (if applicable) http://apdcares.org Failure to submit the requested items along with the signed MWSA will result in the non -renewal of your agreement with the DDWP. Please be aware that you are not entitled to receive payment for services rendered after the expiration date of your MWSA. Please submit your documents via e-mail to Cristina.Quintero@apdcares.org Southernopenenroment@apdcares.orq Sincerely, Cristina Quintero Administrative Secretary APD State of Florida http://apdcares.org Medicaid Waiver Services Contract '21- '22 ADT Jul.'21 Aug.'21 Sept.'21 Oct.'21 Nov.'21 Dec.'21 Jan.'22 Feb.'22 Mar.'22 Apr.'22 May'22 Jun.'22 TOTAL Potential Mo. $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.00 $23,166.001 Potential YTD $23,166.00 $46,332.00 $69,498.00 $92,664.00 $115,830.00 $138,996.00 $162,162.00 $185,328.00 $208,494.00 $231,660.00 $254,826.00 $277,992.00 $277,992.00 Projected Mo. $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 $20,849.40 Actual +/- Proj Mo. Projected YTD $20,849.40 $41,698.80 $62,548.20 $83,397.60 $104,247.00 $125,096.40 $145,945.80 $166,795.20 $187,644.60 $208,494.00 $229,343.40 $250,192.80 $250,192.80 Actual YTD +/- YTD Notes: Number of participants 39 Hourly rate $4.95 6 hour daily rate $29.70 Avg. days per month 20 Projected absentism 10% CITY OF MIAMI CERTIFICATE OF SELF INSURANCE COVERAGE INSURED: CITY OF MIAMI, A POLITICAL SUBDIVISION OF THE STATE OF FLORIDA, ITS EMPLOYEES, AGENTS AND OFFICIALS April 14, 2021 SELF INSURED EVIDENCE OF COVERAGE This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend, nor alter the coverages or defense afforded by the self-insurance plans below. Type of Coverage Effective Date Expiration Date Limits of Liability - in Thousands GENERAL LIABILITY 10/1/90 Until canceled or revoked Bodily Injury, Property Damage Personal Injury Combined $200 per Claimant $300 per Occurrence Self -Insured in accordance with S. 768.28 F.S. (X) Comprehensive (X) Premises/Operations (X) Products/Completed Operations (X) Contractual (X) Independent Contractors (X) Broad Form Property Damage (X) Personal Injury (X) Errors & Omissions AUTOMOBILE LIABILITY 10/1/90 Until canceled or revoked Bodily Injury Property Damage Combined $200 per Claimant $300 per Occurrence Self -Insured in accordance with S.768.28 F.S. (X) Any Auto () All Owned Autos (Private Passenger Autos) ( ) All Owned Autos (Other than Private Passenger) (X) Hired Autos (X) Non Owned Autos WORKERS COMPENSATION AND 10/1/90 Until canceled or revoked WC Statutory Limits - Florida Self -Insured in accordance with S.440 F.S. EMPLOYERS LIABILITY BLANKET DISHONESTY BOND 10/1/90 Until canceled or revoked $25 Per Occurrence Self -Insured in accordance with S.768.28 F.S. (Including faithful performance, money & securities & depositors forgery) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL/ITEMS: Re: MEDICARE WAIVER AGREEMENT CANCELLATION: Should any of the above described coverages be cancelled before the expiration thereof, the issuing City will endeavor to mail 10 days to mail such notice shall impose no obligation, or liability of any kind upon the City its agents, or written notice to the Certificate Holder named, but failure representatives. ADP 401 N.W. 2ndAvenue eFll Suite Miami, Florida 33128 FRANK GOMEZ Frank Gomez Property & Casualty Manager/Ann Marie Sharpe, Director of Risk Management Risk Management Department, 444 SW 2nd Ave, Miami, FL 33130 (305) 416-1740