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RON DESANTIS
GOVERNOR
JASON WEIDA
SECRETARY
January 8, 2025
Lucy Cruz, AdministratorFile Number: 12962309
Tranquility Bay Adult Day CareCorpLicense Number: 9217
100980 Overseas HwyProvider Type: Adult Day Care Center
KeyLargo, FL 33037-2560Application Number: 6708
RE: Facility located at 100980 Overseas Hwy, Key Largo
Dear Administrator:
The enclosed Adult Day Care Centerlicense with license number 9217and certificate number
4822isissued for the above provider effective June 18, 2024through June 17, 2026.The license
is being issued for approval of therenewalapplication.
The Agency no longer mails hard copies of licenses. Per Section 408.804(2), Florida Statutes,
providers are required to print the license and post it in a conspicuous place readily visible to
clients at the entrance of your facility.
Review your certificate thoroughly to ensure that all information is correct and consistent with
your records. If errors are noted, please contact the Assisted Living Unit.
Please take a short customer satisfaction survey on our website at ahca.myflorida.com/survey/to
let us know how we can serve you better. Additional licensure information can be found at
http://ahca.myflorida.com/assistedliving.
If you have any questions or need further assistance, please contact me at (850) 412-4476or
email me at Sonja.Bradwell@ahca.myflorida.com.
Sincerely,
Sonja Bradwell
SonjaBradwell
Health Services & Facilities Consultant
Assisted Living Unit
Division of Health Care Policy and Oversight
Agency for Healthcare Administration
Facebook.com/AHCAFlorida
2727 Mahan Drive MS#30
X.com/AHCA_FL
Tallahassee, FL 32308
AHCA.MyFlorida.com
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REQUESTFOR WAIVER OFINSURANCEREQUIREMENTS
Itis requestedthattheinsurancerequirements,asspecifiedinthe ScheduleofInsurance
Requirements,bewaivedormodifiedonthefollowingcontract.
Contractor/Vendor:
ProjectorService:
Contractor/Vendor
Address&Phone#:
GeneralScopeofWork:
ReasonforWaiveror
Modification:
PoliciesWaiveror
Modificationwillapplyto:
SignatureofContractor/Vendor:
Date:ApprovedNotApproved
RiskManagementSignature:_
Date:
CountyAdministratorappeal:
Approved:NotApproved:
Date:
BoardofCountyCommissionersappeal:
Approved:NotApproved:
MeetingDate:
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NOTICE OF ELECTION TO BE EXEMPT
If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption. An
officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter.
Section1:
APPLICANT INFORMATION
First & Last Name:LORENAMSANTANA
VALID State Driver's License Number:State:FLFlorida ID Number:
S535533976790
Driver's License Expiration Date:5/19/2031
Date of Birth:
5/19/1997
Email Address:TRANQUILITYBAYADULTDAYCAREKEYM@GMAIL.COM
Section2:
NON-CONSTRUCTION INDUSTRY APPLICANT (NO FEE REQUIRED)
Officer of a Corporation
Section 3:
This section should be completed with information specific to your corporation or to the limited liability company in which you are
a member. The name of the corporation or limited liability company listed on this application MUST match the name of the
corporation or limited liability company as registered with the Florida Division of Corporations.
Name of Corporation or LLC:TRANQUILITY BAY ADULT DAY CARE OF FEIN:820609905
MARATHON, CORP
Business Name (DBA): Phone:7865725498
Applicant's Address of Record: 11524 OVERSEAS HIGHWAY
City:MARATHONState:FLZip33050County:MONROE
Section4:
The corporation of which you are an officer or limited liability company of which you are a member must be registered and in ACTIVE status
with the Florida Division of Corporations. Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with
the Florida Division of Corporations. List the document number on file with the Florida Division of Corporations.
P17000018711
Section 5:
THIS SECTION IS NOT APPLICABLE TO MY BUSINESS.
DBPR License Number:
Additional DBPR License Number:
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Section 6:
If you have submitted an electronic payment for this application, the transaction confirmation number is listed in the following space:
Confirmation Number:Application Number:E02208117
Section 7:N/A
Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which
this application applies?
Section 8: CONSTRUCTION INDUSTRY AND NON-CONSTRUCTION INDUSTRY LLC MEMBERS ONLY
To be eligible for a construction industry exemption or a non-construction limited liability company exemption, an applicant must
have the required ownership of the corporation or limited liability company.
Section 9:
I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by
workers' compensation insurance. Please identify the workers' compensation insurance carrier that covers any non-exempt
employees.
Carrier Name:My business does not have any non-exempt employees; or, my business is not required to obtain workers'
compensation.
Section 10: FRAUD NOTICE
Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer or employee,
A.
insurance company or any other person, files a Notice of Election to be Exempt containing any false or misleading
information is guilty of a felony of the third degree.
B.
Attestation of applicant By providing my name below, I attest that I have read, understand and acknowledge the
foregoing notice.
C.I acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any
affiliated corporations as provided in Section 440.02, Florida Statutes.
D.I certify I reviewed and understand the workerscompensation coverage and compliance tutorial developed by the
department.
First Name:Last Name:Driver's License Number OR Identification Card Number:
LORENASANTANAS535533976790
Note: The Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of
an exemption. The Division will either issue a Certificate of Election to be Exempt or notify you that your application is incomplete.
The Division reviews and processes exemption applications in the order they are received.
Exemption information is reflected on the Exemption Search database the day following the issuance of the exemption.
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