Dear RBWO Providers:

As we approach fiscal year 2022 contract cycle, our goal is to ensure that all FY22 contracts are executed timely and efficiently. The Office of Provider Management (OPM) has developed a new process for obtaining and submitting agency’s yearly and/or ongoing contract documents via GA+SCORE. For your convenience, we’ve gathered all of the current updated documents that will need to be completed including any vendor request changes. (Note that file is a 12 MB zip file.) OPM will need all documents listed below completed and uploaded in GA SCORE (DO NOT EMAIL) by close of business on December 31, 2020. The deadline cannot be extended to ensure all contracts are executed timely.  

OPM along with Care Solutions will provide a mandatory training to discuss all changes and process for uploading required documents is scheduled for December 3, 2020. There will be three sessions provided; however, agency representation is only required for one session. (Preferable that staff involved in completing contract documents attend.)

• 9:30-11:00 a.m. Session Link:
  Click here to join the meeting
  470-344-9228, Phone Conference ID: 819 836 650#
   
• 1:00- 2:30 p.m. Session Link:
  Click here to join the meeting
  470-344-9228, Phone Conference ID: 991 163 456#
   
• 3:00-4:30 p.m. Session Link:
  Click here to join the meeting
  470-344-9228, Phone Conference ID: 986 387 903#

If you have questions or concerns, please contact Brenda Jones and/or LaShaunda Daniel: Brenda Jones at Brenda.Jones@dhs.ga.gov or 404-232-7860. LaShaunda Daniel at LaShaunda.Daniel@dhs.ga.gov or 404-657-0919.

• Georgia Secretary of State Corporations Divisions (Print document showing Active/Compliance for year 2021- https://ecorp.sos.ga.gov/)
• Corporate Resolution Letter (Not-for-Profit-Only) (See sample in zip file) Please include the following:
  • Contract period beginning July 1, 2021 and ending June 30, 2022
  • Your Agency seal (Ensure that the seal is visible and readable).
• Criminal Background Form
• Security & Immigration Compliance Form
• Tax Compliance Form
• Void Business Check with Agency name
• W-9  (New form in zip file)
• Vendor Management Form (New form in zip file) Please do not send previous forms.
• Vendor-Provider Request Form (This form will hold 3 locations).
  • Any change request to your contract (New locations, moves, program designations, capacity, closing locations, etc.) must be listed on a vendor request change form located in GA SCORE.
• Certificate of Liability Insurance (Please do not send actual policies. Single page from insurance company are required for all coverages listed below).
  • Malpractice/Professional Liability Policy (Claims Based) with EDP, Errors and Omissions Coverage. $1 million per occurrence/$3 million aggregate policy limits.
  • Commercial General Liability Policy (Occurrence) to include contractual liability. $1 million per occurrence/$3 million dollar aggregate policy limits.
  • Business Auto Policy (Occurrence) to include but not be limited to liability coverage on any owned, non owned and hired vehicle used by Contractor or Contractor’s personnel in the performance of this Contract. $1 million per occurrence/$3 million dollar aggregate policy limits.
  • Commercial Umbrella Policy (Occurrence). An umbrella policy may cover the aggregate policy limits required herein. There must be no gap between the $1 million and $3million dollar policy limits and the umbrella policy must follow the form of the underlying $1 million primary policy.
  • Workers Compensation Insurance (Occurrence) in the amounts of the statutory limits established by the General Assembly of the State of Georgia in Title 34, Chapter 9 of the O.C.G.A. (A self-insurer must submit a certificate from the Georgia Board of Workers Compensation stating that Contractor qualifies to pay its own workers compensation claims). Contractor shall require all subcontractors that are required by stature to hold workers compensation insurance and that occupy the premises or perform work under this Contract to obtain an insurance certificate showing proof of Worker Compensation Coverage.

Sincerely,

The Office of Provider Management (OPM)