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 information including the contractor's name, contract number, invoice details, service location, and contact information.

The invoice template is structured to capture service units, number of juveniles served, unit rates, and total invoice amount. Contractors must provide services without discrimination and certify the accuracy of their invoice through an authorized representative's signature. The document appears to be a standardized billing instrument for residential service providers working with the Arizona Department of Juvenile Corrections, with a revision date of January 3, 2023. The invoice requires comprehensive documentation of services rendered, including full cost, units provided, and a breakdown of juvenile services.