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 services, specifically for congregate care (group home) or behavioral health residential facilities serving juvenile populations. The template is structured to capture key billing information including contractor name, contract number, invoice details, service type, and contact information.

The invoice template allows for billing based on units of service, with a designated space to record the number of ADJC juveniles served, units provided, and the contract unit rate. The form includes a certification statement requiring the authorized representative to verify the accuracy of services, confirm non-discriminatory service provision, and attest that the invoice represents the full and complete charge for services rendered. The document was revised on 1/03/23 and provides a standardized format for contractors to submit invoices for residential services to the Arizona Department of Juvenile Corrections.