Exhibit XXII ADJC Residential Services Invoice.docx

This document is an invoice template for the Arizona Department of Juvenile Corrections (ADJC) Residential Services contract. The invoice form is designed for contractors providing residential care services, specifically for congregate care (group home) or behavioral health residential facilities serving juvenile populations. The template requires detailed documentation from the contractor, including contract number, invoice number, service period, and contact information.

The invoice template covers residential service units, with provisions for tracking the number of juveniles served, units provided, and corresponding unit rates. Contractors must complete the invoice with their full cost, unit pricing, and total invoice amount. A mandatory certification statement requires the authorized representative to affirm the invoice's accuracy, service provision without discrimination, and agreement that the statement is subject to federal and state audit review. The document was revised on 1/03/23, indicating it is a current operational form for managing state-level juvenile residential service contracts.