MARICOPA - NEW IGA - COFC - DI18-002178-CURRENT.PDF
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DEPARTMENT OF ECONOMIC SECURITY
Your Partner Tor A Stenger Arizona
INTERGOVERNMENTAL AGREEMENT (IGA)
Agreement between the Arizona Department of Economic Security ("ADES") and the Clerk of the Superior
Courtin and for Maricopa County ("the Clerk").
WHEREAS ADES is duly authorized to execute and administer contracts under A.R.S § 41-1954; and
Clerk is duly authorized to execute and administer contracts under A.R.S § 12-283; and
ADES and the Clerk are authorized by A.R.S, § 11-952 et seq. to enter into agreements for joint or
cooperative
action to contract for the services specified in this Agreement.
The term of this Agreement shall begin on the date of July 1, 2018:and shall end on September 30, 2023, unless
otherwise amended.
THEREFORE, ADES and Clerk (the Parties”)
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OFFICE OF THE ARIZONA ATTORNEY GENERAL
MARK BRNOVICH
ATTORNEY GENERAL STATE GOVERNMENT DIVision
AGENCY COUNSEL SECTION
nn
rirancovEi DETERMINATION
AGREEMENT
. * K R 18-0728 w y ,
Attorney General Contract No. which is an Agreement
between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned
Assistant Attorney General, who has determined that it is in the proper form and is within the
powers granted under the laws of the State of Arizona to those Parties to the Agreement
represented by the Attorney General,
Dated this |
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ADES VISION AND Mission STATEMENTS
a a NaS ADES Vision: Opportunity, assistance and care for Arizonans In need,
ADES Mission: The Arizona Department of Economic Security makes Arizona stronger by helping Arizonans
reach their potential through temporary assistance for those in need and care for the vulnerable.
PURPOSE OF AGREEMENT
2.1. The purpose of this agreement Js to establish responsibilities between the parties regarding Title IV-D |
operations and other required functions, with regard to reimbursable child support activities.
3.0 DEFINITIONS
Arizona Tracking and! Location Automated System (ATLAS): The mainframe based statewide automated
system for IV-D child support cases,
3.2, Automated Clearing House (ACH): An electronic funds-transfer system run by the National Automated
Clearing House Association (NACHA}.
3.3, Business Day: Every official workday of the week. Typleailly, these are the days between and including
Monday to Friday excluding official Arizona State holidays as defined by DCSS Locations. The Clerk will
have read
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5 1 10 8 2 3 603 1428 129 38 96.578148 support
5 1 10 8 2 4 745 1431 140 33 94.985779 program
5 1 10 8 2 5 898 1425 65 30 94.985779 that
5 1 10 8 2 6 972 1424 27 31 73.440346 Is
5 1 10 8 2 7 1010 1422 177 33 95.779457 authorized
5 1 10 8 2 8 1200 1422 42 39 96.388672 by
5 1 10 8 2 9 1254 1421 60 31 93.217102 title
5 1 10 8 2 10 1326 1420 62 32 28.286053 iv-d
5 1 10 8 2 11 1399 1419 35 32 95.938454 of
5 1 10 8 2 12 1443 1421 50 30 95.938454 the
5 1 10 8 2 13 1506 1419 95 32 96.647423 social
5 1 10 8 2 14 1611 1417 132 41 96.608925 security
5 1 10 8 2 15 1755 1419 60 30 78.618721 act,
3 1 10 9 0 0 418 1459 1892 97 -1
4 1 10 9 1 0 418 1459 1892 47 -1
5 1 10 9 1 1 418 1470 166 33 64.881653 Non-lV-D
5 1 10 9 1 2 598 1477 94 25 96.807777 case:
5 1 10 9 1 3 708 1470 28 30 96.779922 A
5 1 10 9 1 4 747 1467 78 33 95.761124 child
5 1 10 9 1 5 841 1467 128 39 96.463730 support
5 1 10 9 1 6 981 1465 90 34 96.779434 order
5 1 10 9 1 7 1083 1465 66 34 96.428658 that
5 1 10 9 1 8 1162 1465 26 32 96.781685 is
5 1 10 9 1 9 1204 1466 56 31 96.943481 not
5 1 10 9 1 10 1273 1464 95 39 96.671898 being
5 1 10 9 1 11 1383 1462 146 35 96.785774 enforced
5 1 10 9 1 12 1543 1462 41 40 91.559853 by
5 1 10 9 1 13 1599 1462 51 34 93.299049 the
5 1 10 9 1 14 1665 1461 177 35 89.265411 State/local
5 1 10 9 1 15 1857 1461 81 32 96.747704 child
5 1 10 9 1 16 1953 1461 129 39 96.923759 support
5 1 10 9 1 17 2097 1459 213 33 95.879410 enforcement
4 1 10 9 2 0 418 1515 248 41 -1
5 1 10 9 2 1 418 1515 104 41 74.705948 (IV-D)
5 1 10 9 2 2 535 1521 131 33 80.652153 agency,
3 1 10 10 0 0 418 1548 1888 48 -1
4 1 10 10 1 0 418 1548 1888 48 -1
5 1 10 10 1 1 418 1560 154 30 25.397869 Nattonal
5 1 10 10 1 2 583 1558 199 32 96.273895 Automated
5 1 10 10 1 3 796 1557 149 39 35.019192 Clearing
5 1 10 10 1 4 960 1555 114 32 96.680145 House
5 1 10 10 1 5 1086 1554 221 32 47.999821 Association
5 1 10 10 1 6 1320 1552 171 40 57.476772 (NACHA):
5 1 10 10 1 7 1504 1552 67 32 96.792480 The
5 1 10 10 1 8 1581 1551 191 30 96.656425 association
5 1 10 10 1 9 1784 1551 64 31 96.919533 that
5 1 10 10 1 10 1859 1549 193 32 96.505272 establishes
5 1 10 10 1 11 2064 1549 56 38 96.997978 the
5 1 10 10 1 12 2130 1548 176 37 96.962547 standards,
2 1 11 0 0 0 950 1278 325 6 -1
3 1 11 1 0 0 950 1278 325 6 -1
4 1 11 1 1 0 950 1278 325 6 -1
5 1 11 1 1 1 950 1278 325 6 95.000000
2 1 12 0 0 0 414 1281 352 7 -1
3 1 12 1 0 0 414 1281 352 7 -1
4 1 12 1 1 0 414 1281 352 7 -1
5 1 12 1 1 1 414 1281 352 7 95.000000
2 1 13 0 0 0 393 1591 1916 52 -1
3 1 13 1 0 0 393 1591 1916 52 -1
4 1 13 1 1 0 393 1591 1916 52 -1
5 1 13 1 1 1 393 1605 120 36 77.331825 _tules,
5 1 13 1 1 2 538 1604 61 31 96.569740 and
5 1 13 1 1 3 623 1602 192 41 96.499718 procedures
5 1 13 1 1 4 837 1600 63 32 96.692337 that
5 1 13 1 1 5 921 1599 114 33 96.653458 enable
5 1 13 1 1 6 1057 1599 139 32 96.595383 financial
5 1 13 1 1 7 1221 1597 185 34 95.771805 institutions
5 1 13 1 1 8 1428 1599 29 30 91.121742 to
5 1 13 1 1 9 1480 1596 164 39 96.330063 exchange
5 1 13 1 1 10 1666 1596 166 39 96.469025 payments
5 1 13 1 1 11 1854 1602 47 24 96.202553 on
5 1 13 1 1 12 1911 1589 20 58 90.485817 a
5 1 13 1 1 13 1964 1593 133 33 90.485817 national
5 1 13 1 1 14 2124 1591 96 34 80.350090 basis.
5 1 13 1 1 15 2243 1593 66 32 96.685684 The
2 1 14 0 0 0 278 1740 61 30 -1
3 1 14 1 0 0 278 1740 61 30 -1
4 1 14 1 1 0 278 1740 61 30 -1
5 1 14 1 1 1 278 1740 61 30 94.264946 3.9.
2 1 15 0 0 0 279 2006 62 75 -1
3 1 15 1 0 0 279 2006 62 75 -1
4 1 15 1 1 0 279 2006 51 28 -1
5 1 15 1 1 1 279 2006 51 28 94.455879 4.0
4 1 15 1 2 0 279 2049 62 32 -1
5 1 15 1 2 1 279 2049 62 32 62.244038 4,1.
2 1 16 0 0 0 280 2226 52 32 -1
3 1 16 1 0 0 280 2226 52 32 -1
4 1 16 1 1 0 280 2226 52 32 -1
5 1 16 1 1 1 280 2226 52 32 89.928574 5.0
2 1 17 0 0 0 282 2360 129 75 -1
3 1 17 1 0 0 282 2360 129 75 -1
4 1 17 1 1 0 282 2360 62 31 -1
5 1 17 1 1 1 282 2360 62 31 69.048248 5.17.
4 1 17 1 2 0 318 2403 93 32 -1
5 1 17 1 2 1 318 2403 93 32 67.366768 5.1.1,
2 1 18 0 0 0 318 2493 94 32 -1
3 1 18 1 0 0 318 2493 94 32 -1
4 1 18 1 1 0 318 2493 94 32 -1
5 1 18 1 1 1 318 2493 94 32 79.023186 5.9.2.
2 1 19 0 0 0 417 1636 1895 311 -1
3 1 19 1 0 0 418 1636 1892 89 -1
4 1 19 1 1 0 418 1636 1892 44 -1
5 1 19 1 1 1 418 1647 172 33 95.700844 Electronic
5 1 19 1 1 2 612 1645 105 34 96.947342 Funds
5 1 19 1 1 3 738 1645 146 34 96.268471 Transfer
5 1 19 1 1 4 903 1644 62 33 96.784714 and
5 1 19 1 1 5 985 1644 53 33 96.277267 the
5 1 19 1 1 6 1059 1642 77 34 96.883163 child
5 1 19 1 1 7 1158 1642 135 38 96.544151 support
5 1 19 1 1 8 1314 1641 167 33 63.981041 Electronic
5 1 19 1 1 9 1501 1641 82 32 96.679512 Data
5 1 19 1 1 10 1603 1639 203 38 96.227043 Interchange
5 1 19 1 1 11 1826 1638 130 33 96.333733 formats
5 1 19 1 1 12 1976 1647 57 23 96.945107 are
5 1 19 1 1 13 2052 1636 195 34 96.566467 established
5 1 19 1 1 14 2271 1636 39 40 96.566467 by
4 1 19 1 2 0 418 1681 1661 44 -1
5 1 19 1 2 1 418 1692 146 33 83.941917 NACHA.
5 1 19 1 2 2 579 1691 135 33 91.111328 NACHA
5 1 19 1 2 3 724 1689 70 33 94.894035 also
5 1 19 1 2 4 805 1688 190 33 96.640968 establishes
5 1 19 1 2 5 1009 1688 79 33 96.215080 rules
5 1 19 1 2 6 1098 1688 63 31 96.901855 and
5 1 19 1 2 7 1176 1686 197 39 95.864128 procedures
5 1 19 1 2 8 1384 1686 64 32 96.917030 that
5 1 19 1 2 9 1456 1692 115 32 96.675659 govern
5 1 19 1 2 10 1584 1692 62 23 96.675659 use
5 1 19 1 2 11 1656 1683 36 32 96.163490 of
5 1 19 1 2 12 1698 1683 51 32 96.163490 the
5 1 19 1 2 13 1764 1682 105 33 96.387024 stored
5 1 19 1 2 14 1883 1682 93 31 96.879921 value
5 1 19 1 2 15 1985 1681 94 32 96.255371 cards
3 1 19 2 0 0 417 1725 1895 222 -1
4 1 19 2 1 0 417 1725 1895 50 -1
5 1 19 2 1 1 417 1737 153 38 95.679550 Support
5 1 19 2 1 2 580 1736 129 31 88.557800 orders:
5 1 19 2 1 3 724 1734 122 32 95.535141 include
5 1 19 2 1 4 859 1733 71 33 96.618614 both
5 1 19 2 1 5 942 1733 78 30 96.618614 child
5 1 19 2 1 6 1032 1733 130 39 96.337814 support
5 1 19 2 1 7 1173 1731 65 30 96.934875 and
5 1 19 2 1 8 1251 1730 135 40 96.955978 spousal
5 1 19 2 1 9 1399 1728 217 33 96.954407 maintenance
5 1 19 2 1 10 1627 1727 115 33 92.700073 orders,
5 1 19 2 1 11 1772 1728 139 38 95.422157 Support
5 1 19 2 1 12 1922 1733 112 25 96.889984 means
5 1 19 2 1 13 2046 1727 54 31 96.726837 the
5 1 19 2 1 14 2114 1725 151 39 96.904358 provision
5 1 19 2 1 15 2279 1725 33 30 96.904358 of
4 1 19 2 2 0 420 1769 1887 45 -1
5 1 19 2 2 1 420 1782 222 32 96.870003 maintenance
5 1 19 2 2 2 666 1787 35 24 96.728523 or
5 1 19 2 2 3 723 1779 203 32 96.470390 subsistence
5 1 19 2 2 4 948 1778 63 31 96.705521 and
5 1 19 2 2 5 1036 1778 140 31 82.766708 Includes
5 1 19 2 2 6 1202 1776 133 32 92.013779 medical
5 1 19 2 2 7 1362 1776 164 29 95.795189 Insurance
5 1 19 2 2 8 1548 1779 165 33 95.767601 coverage,
5 1 19 2 2 9 1739 1781 39 22 95.767601 or
5 1 19 2 2 10 1799 1772 108 31 96.733551 chase
5 1 19 2 2 11 1929 1772 129 31 87.636749 medical
5 1 19 2 2 12 2084 1773 136 39 96.677681 support,
5 1 19 2 2 13 2246 1769 61 33 96.907181 and
4 1 19 2 3 0 420 1815 1892 44 -1
5 1 19 2 3 1 420 1824 180 35 95.876671 uncovered
5 1 19 2 3 2 622 1823 133 34 95.869789 medical
5 1 19 2 3 3 772 1824 92 32 96.984665 costs
5 1 19 2 3 4 882 1824 48 30 96.994385 for
5 1 19 2 3 5 947 1823 52 31 96.795662 the
5 1 19 2 3 6 1020 1820 86 39 93.288231 child,
5 1 19 2 3 7 1128 1829 200 30 92.463058 arrearages,
5 1 19 2 3 8 1353 1818 125 33 96.312820 interest
5 1 19 2 3 9 1497 1827 39 23 93.249802 on
5 1 19 2 3 10 1558 1826 193 30 89.166649 arrearages,
5 1 19 2 3 11 1776 1817 72 40 96.420212 past
5 1 19 2 3 12 1868 1817 138 39 95.127602 support,
5 1 19 2 3 13 2030 1815 124 33 96.277519 interest
5 1 19 2 3 14 2174 1821 42 26 96.277519 on
5 1 19 2 3 15 2238 1815 74 38 96.298401 past
4 1 19 2 4 0 418 1859 1891 49 -1
5 1 19 2 4 1 418 1871 134 37 96.262131 support
5 1 19 2 4 2 574 1869 66 32 96.696373 and
5 1 19 2 4 3 667 1866 254 35 95.137787 reimbursement
5 1 19 2 4 4 945 1865 47 33 96.851845 for
5 1 19 2 4 5 1017 1865 164 39 95.869530 expended
5 1 19 2 4 6 1211 1863 103 41 94.937973 public
5 1 19 2 4 7 1339 1863 188 32 95.904366 assistance.
5 1 19 2 4 8 1555 1862 29 31 93.733269 In
5 1 19 2 4 9 1611 1868 23 24 78.075226 a
5 1 19 2 4 10 1657 1860 59 32 74.537056 title
5 1 19 2 4 11 1742 1860 84 38 26.844288 IV-D,
5 1 19 2 4 12 1856 1862 130 37 96.723236 support
5 1 19 2 4 13 2012 1860 139 30 79.596153 includes
5 1 19 2 4 14 2178 1859 131 39 91.292068 spousal
4 1 19 2 5 0 420 1907 1236 40 -1
5 1 19 2 5 1 420 1914 224 33 95.757698 maintenance
5 1 19 2 5 2 655 1913 64 31 96.370224 that
5 1 19 2 5 3 730 1913 25 30 96.558029 is
5 1 19 2 5 4 766 1911 143 32 96.453911 included
5 1 19 2 5 5 921 1910 27 31 96.317871 in
5 1 19 2 5 6 961 1910 52 31 96.702682 the
5 1 19 2 5 7 1024 1917 94 23 96.839684 same
5 1 19 2 5 8 1129 1908 92 32 96.743729 order
5 1 19 2 5 9 1233 1908 65 32 94.381897 that
5 1 19 2 5 10 1309 1907 115 33 96.833092 directs
5 1 19 2 5 11 1434 1907 75 31 96.878311 child
5 1 19 2 5 12 1521 1907 135 37 95.905716 support.
2 1 20 0 0 0 420 2003 1892 171 -1
3 1 20 1 0 0 421 2003 367 31 -1
4 1 20 1 1 0 421 2003 367 31 -1
5 1 20 1 1 1 421 2004 143 30 96.653152 SERVICE
5 1 20 1 1 2 573 2003 215 30 45.425396 DESCRIPTION
3 1 20 2 0 0 420 2036 1892 138 -1
4 1 20 2 1 0 420 2036 1890 48 -1
5 1 20 2 1 1 420 2048 69 31 96.728218 The
5 1 20 2 1 2 507 2046 90 32 79.296173 Clerk
5 1 20 2 1 3 612 2054 149 30 96.410339 engages
5 1 20 2 1 4 777 2043 30 33 85.978241 in
5 1 20 2 1 5 825 2042 213 34 92.188622 court-related
5 1 20 2 1 6 1057 2042 125 33 96.849144 records
5 1 20 2 1 7 1202 2039 231 40 95.439713 management
5 1 20 2 1 8 1447 2039 61 33 96.242935 and
5 1 20 2 1 9 1525 2039 140 31 87.303413 financial
5 1 20 2 1 10 1683 2037 141 33 96.570282 services
5 1 20 2 1 11 1841 2037 33 30 91.246841 fo
5 1 20 2 1 12 1895 2037 129 39 96.769028 support
5 1 20 2 1 13 2039 2037 52 30 96.907310 the
5 1 20 2 1 14 2111 2037 85 32 96.812813 court
5 1 20 2 1 15 2211 2036 29 33 96.811462 in
5 1 20 2 1 16 2258 2036 52 31 96.984215 the
4 1 20 2 2 0 420 2081 1892 48 -1
5 1 20 2 2 1 420 2090 243 33 95.322784 administration
5 1 20 2 2 2 694 2088 62 32 95.322784 and
5 1 20 2 2 3 789 2088 183 41 95.395294 processing
5 1 20 2 2 4 1004 2087 46 31 92.554123 for
5 1 20 2 2 5 1078 2085 260 41 61.556210 supportrelated
5 1 20 2 2 6 1374 2084 204 40 96.024612 proceedings
5 1 20 2 2 7 1611 2082 27 32 94.588921 in
5 1 20 2 2 8 1671 2082 146 41 95.931145 Superior
5 1 20 2 2 9 1847 2082 103 30 81.742363 Court.
5 1 20 2 2 10 1983 2081 72 31 95.519188 This
5 1 20 2 2 11 2088 2081 141 31 91.707039 includes
5 1 20 2 2 12 2261 2081 51 31 91.707039 the
4 1 20 2 3 0 421 2130 874 44 -1
5 1 20 2 3 1 421 2136 230 38 96.365990 management
5 1 20 2 3 2 660 2133 33 33 96.997635 of
5 1 20 2 3 3 704 2133 67 32 96.922737 Non
5 1 20 2 3 4 786 2133 72 32 85.869545 IV-D
5 1 20 2 3 5 871 2132 128 39 96.065895 support
5 1 20 2 3 6 1009 2139 97 23 96.645203 cases
5 1 20 2 3 7 1118 2132 28 28 96.519836 in
5 1 20 2 3 8 1159 2130 136 32 93.991066 ATLAS.
2 1 21 0 0 0 420 2226 1895 606 -1
3 1 21 1 0 0 421 2226 296 30 -1
4 1 21 1 1 0 421 2226 296 30 -1
5 1 21 1 1 1 421 2226 296 30 95.565201 RESPONSIBILITIES
3 1 21 2 0 0 420 2265 644 39 -1
4 1 21 2 1 0 420 2265 644 39 -1
5 1 21 2 1 1 420 2268 109 33 92.364944 ADES
5 1 21 2 1 2 541 2267 61 33 96.583305 and
5 1 21 2 1 3 614 2267 55 33 96.762894 the
5 1 21 2 1 4 679 2267 89 33 96.835556 Clerk
5 1 21 2 1 5 780 2273 98 31 96.736588 agree
5 1 21 2 1 6 889 2273 38 22 96.913559 as
5 1 21 2 1 7 937 2265 127 30 0.000000 follows:
3 1 21 3 0 0 421 2312 476 37 -1
4 1 21 3 1 0 421 2312 476 37 -1
5 1 21 3 1 1 421 2313 70 32 96.300621 The
5 1 21 3 1 2 502 2312 91 33 96.083443 Clerk
5 1 21 3 1 3 603 2312 87 37 87.808403 shall:
3 1 21 4 0 0 423 2357 1892 253 -1
4 1 21 4 1 0 423 2357 422 33 -1
5 1 21 4 1 1 423 2360 159 28 94.479179 GENERAL
5 1 21 4 1 2 590 2357 255 33 96.250130 REQUIREMENTS
4 1 21 4 2 0 459 2390 1856 49 -1
5 1 21 4 2 1 459 2400 138 33 95.197807 Forward
5 1 21 4 2 2 630 2400 38 32 95.197807 all
5 1 21 4 2 3 697 2400 131 39 95.967232 support
5 1 21 4 2 4 856 2399 173 40 95.995415 payments,
5 1 21 4 2 5 1062 2396 147 39 96.486694 including
5 1 21 4 2 6 1243 2402 98 33 96.733002 purge
5 1 21 4 2 7 1374 2394 170 41 96.823410 payments,
5 1 21 4 2 8 1576 2394 32 32 96.846107 to
5 1 21 4 2 9 1636 2393 55 31 96.380028 the
5 1 21 4 2 10 1718 2391 129 33 95.038261 Arizona
5 1 21 4 2 11 1881 2390 85 33 95.038261 Child
5 1 21 4 2 12 1997 2390 138 42 95.828865 Support
5 1 21 4 2 13 2162 2390 153 39 95.828865 Payment
4 1 21 4 3 0 459 2438 1109 46 -1
5 1 21 4 3 1 459 2444 249 40 93.920822 Clearinghouse
5 1 21 4 3 2 719 2442 47 33 96.838799 for
5 1 21 4 3 3 775 2442 121 41 96.838799 posting
5 1 21 4 3 4 907 2441 97 34 96.573883 within
5 1 21 4 3 5 1017 2442 59 32 93.388084 two
5 1 21 4 3 6 1087 2441 44 39 95.753700 (2)
5 1 21 4 3 7 1145 2439 156 33 96.122139 business
5 1 21 4 3 8 1312 2439 83 41 96.440575 days
5 1 21 4 3 9 1407 2438 32 34 93.139015 of
5 1 21 4 3 10 1448 2438 120 39 46.042084 recelpt,
4 1 21 4 4 0 459 2480 1854 48 -1
5 1 21 4 4 1 459 2493 123 29 96.941940 Ensure
5 1 21 4 4 2 604 2490 68 30 95.565918 that
5 1 21 4 4 3 696 2489 120 39 92.651398 County
5 1 21 4 4 4 841 2487 107 32 96.746078 issued
5 1 21 4 4 5 973 2486 119 31 96.609055 checks
5 1 21 4 4 6 1114 2484 68 32 96.897667 with
5 1 21 4 4 7 1212 2484 133 39 93.623581 multiple
5 1 21 4 4 8 1371 2484 116 38 93.390587 obligor
5 1 21 4 4 9 1509 2483 165 39 46.859074 payments
5 1 21 4 4 10 1700 2489 53 22 96.175156 are
5 1 21 4 4 11 1779 2480 230 40 95.995468 accompanied
5 1 21 4 4 12 2034 2480 41 40 95.646667 by
5 1 21 4 4 13 2100 2489 21 22 95.457245 a
5 1 21 4 4 14 2144 2480 169 30 95.457245 document
4 1 21 4 5 0 457 2523 1855 50 -1
5 1 21 4 5 1 457 2535 178 38 89.423302 containing
5 1 21 4 5 2 661 2532 188 33 79.337555 information
5 1 21 4 5 3 871 2538 175 32 96.263588 necessary
5 1 21 4 5 4 1068 2531 30 30 96.263588 to
5 1 21 4 5 5 1122 2531 75 39 96.467285 post
5 1 21 4 5 6 1219 2529 54 32 96.416832 the
5 1 21 4 5 7 1299 2528 167 40 96.772919 payments
5 1 21 4 5 8 1488 2526 180 39 92.790375 accurately.
5 1 21 4 5 9 1695 2526 65 30 92.966286 The
5 1 21 4 5 10 1785 2525 210 31 92.644371 dacumented
5 1 21 4 5 11 2022 2523 189 33 93.231422 information
5 1 21 4 5 12 2237 2523 75 32 92.898636 shall
4 1 21 4 6 0 459 2577 375 33 -1
5 1 21 4 6 1 459 2580 123 30 32.064747 include
5 1 21 4 6 2 593 2579 33 30 96.345047 at
5 1 21 4 6 3 636 2586 21 23 95.839775 a
5 1 21 4 6 4 669 2577 165 32 94.593262 minimum:
3 1 21 5 0 0 567 2618 322 47 -1
4 1 21 5 1 0 567 2618 322 47 -1
5 1 21 5 1 1 567 2618 122 47 82.892220 Obligor
5 1 21 5 1 2 707 2618 97 47 96.193062 name,
3 1 21 6 0 0 564 2663 761 39 -1
4 1 21 6 1 0 564 2663 761 39 -1
5 1 21 6 1 1 564 2667 123 32 96.248909 ATLAS
5 1 21 6 1 2 697 2672 80 25 95.650879 case
5 1 21 6 1 3 790 2666 137 36 96.079391 number,
5 1 21 6 1 4 940 2670 35 26 96.370842 or
5 1 21 6 1 5 985 2664 86 32 52.102108 court
5 1 21 6 1 6 1081 2664 90 30 93.339317 order
5 1 21 6 1 7 1182 2663 143 36 95.669998 number,
3 1 21 7 0 0 564 2709 225 39 -1
4 1 21 7 1 0 564 2709 225 39 -1
5 1 21 7 1 1 564 2712 135 32 93.222412 Amount
5 1 21 7 1 2 709 2709 80 39 92.417969 pald,
3 1 21 8 0 0 567 2753 477 42 -1
4 1 21 8 1 0 567 2753 477 42 -1
5 1 21 8 1 1 567 2756 81 33 96.667290 Date
5 1 21 8 1 2 660 2756 147 39 95.951225 payment
5 1 21 8 1 3 817 2753 152 37 95.827164 received,
5 1 21 8 1 4 981 2753 63 31 96.669144 and
3 1 21 9 0 0 567 2795 954 37 -1
4 1 21 9 1 0 567 2795 954 37 -1
5 1 21 9 1 1 567 2799 189 33 96.523430 Information
5 1 21 9 1 2 769 2807 41 22 96.765373 on
5 1 21 9 1 3 822 2799 138 30 96.803253 whether
5 1 21 9 1 4 970 2798 19 30 81.342461 it
5 1 21 9 1 5 1000 2796 26 32 91.443886 is
5 1 21 9 1 6 1036 2796 47 32 68.249657 for
5 1 21 9 1 7 1092 2805 20 21 68.249657 a
5 1 21 9 1 8 1125 2796 75 30 65.858849 {V-D
5 1 21 9 1 9 1213 2804 38 22 93.246040 or
5 1 21 9 1 10 1261 2795 161 31 15.341988 Non-IV-D
5 1 21 9 1 11 1434 2802 87 23 96.152931 case.
2 1 22 0 0 0 493 2624 41 208 -1
3 1 22 1 0 0 493 2624 41 208 -1
4 1 22 1 1 0 493 2624 41 208 -1
5 1 22 1 1 1 493 2624 41 208 1.625633 moOw>
2 1 23 0 0 0 283 2926 563 9 -1
3 1 23 1 0 0 283 2926 563 9 -1
4 1 23 1 1 0 283 2926 563 9 -1
5 1 23 1 1 1 283 2926 563 9 95.000000
2 1 24 0 0 0 283 2954 18 25 -1
3 1 24 1 0 0 283 2954 18 25 -1
4 1 24 1 1 0 283 2954 18 25 -1
5 1 24 1 1 1 283 2954 18 25 78.412720 a
2 1 25 0 0 0 2123 2993 193 36 -1
3 1 25 1 0 0 2123 2993 193 36 -1
4 1 25 1 1 0 2123 2993 193 36 -1
5 1 25 1 1 1 2123 2994 78 35 95.594604 Page
5 1 25 1 1 2 2211 2993 20 27 96.896378 2
5 1 25 1 1 3 2241 2993 29 28 96.896378 of
5 1 25 1 1 4 2279 2993 37 28 96.677856 20
2 1 26 0 0 0 2546 143 3 328 -1
3 1 26 1 0 0 2546 143 3 328 -1
4 1 26 1 1 0 2546 143 3 328 -1
5 1 26 1 1 1 2546 143 3 328 95.000000
2 1 27 0 0 0 2543 674 7 157 -1
3 1 27 1 0 0 2543 674 7 157 -1
4 1 27 1 1 0 2543 674 7 157 -1
5 1 27 1 1 1 2543 674 7 157 95.000000
3.4.
3.6.
3.7.
3.8.
5.4.3, Review, take action and initiate suspense requests to the State Disbursement Unit within ten (10) days for
‘
final approval. .
5.1.4. Adhere to United State Depariment of Health and Human Services and the Office of Child Support
Enforcement federal guidelines in the handling of collections held in suspense and undisbursed,
5,1.. Be responsible for activating the court action pending recelpt ("R”) narrative on ATLAS for all Non-IV-D court
orders or filings requiring monies to be held based on a court order or a minute entry.
6.1.6. Be responsible for the removal of the “R” narrative In Non- |V-D cases upon resolution of the court action.
5.1.7, Be responsible for all payments misapplied due to the action or Inaction of ihe Clerk and shail be the amount
equal to ADES’ loss. Prior to making a claim for relmbursement to the Clerk, ADES will issue a letter to
any
the Custodial Parent that received the erroneous payment. if the Custodial Parent does not return the
misapplied payment in full or make satisfactory payment arrangements within thirty (30) calendar days,
ADES will invoice the Clerk for the uncollected portion. The Clerk shall have thirty (80) calendar days to pay
or to challenge the Invoice by sending an email to DCSSPIE@azdes.gov. if ADES recovers any amounts
from the Custodial Parent after the Clerk has pald the invoice, ADES will refund the money to the Clerk.
Ensure all debts for all Non-}V-D cases have accurate and defensible balances. The Clerk shall:
A. Make any changes to the debts screens In ATLAS for Non IV-D cases. Debts screens include DELN,
DEDN, SUOD and SUOL.
B. Make any debt adjustments or payment adjustmants in ATLAS. Debt and payment adjustment ATLAS
screens include DARN, DEHA, DEDR, RNRE, SURE, SUPR and PAAR.
5.1.9. Perform all duties assigned pursuant to A.R.S. § 25-510 for Non IV-D cases including:
A. Load ail new support orders in ATLAS ;
B. Modify order amounts in ATLAS
CS. Respond to payment Inquiries
D. Research payment related issues
E, Release payments pursuant to orders of the court
6.1.10. Update and maintain demographic and new employer information for the parties in ATLAS pursuant to
.
A.R.S. § 25-610(C). .
5.1.14, Accept child support payments at each courthouse facility. The Clerk may limit payment types (e.g. cash or
money orders), but must provide to the payor a reasonable mathad for making payments.
5.1.42. Accept checks made payable to the Arizona Child Support Payment Clearinghouse and forward the checks
°
to Clearinghouse for processing.
5.1.13. Complete ADES required forms and ATLAS security training before being assigned log
5 1 8 10 8 13 1998 1761 54 35 96.484459 on”
5 1 8 10 8 14 2069 1761 162 33 96.347572 identifiers
5 1 8 10 8 15 2246 1761 48 33 96.877991 for
4 1 8 10 9 0 440 1812 1183 50 -1
5 1 8 10 9 1 440 1824 131 33 96.426857 ATLAS.
5 1 8 10 9 2 592 1823 77 30 96.961044 This
5 1 8 10 9 3 680 1821 121 41 92.828957 applies
5 1 8 10 9 4 813 1820 32 31 96.600227 to
5 1 8 10 9 5 855 1820 38 30 93.115372 all
5 1 8 10 9 6 906 1818 89 32 94.792000 Clerk
5 1 8 10 9 7 1003 1815 77 35 96.293770 staff
5 1 8 10 9 8 1089 1815 153 39 96.293770 assigned
5 1 8 10 9 9 1255 1815 31 32 94.440231 to
5 1 8 10 9 10 1299 1814 71 31 85.718117 IV-D
5 1 8 10 9 11 1381 1812 86 32 96.823189 Child
5 1 8 10 9 12 1480 1812 143 39 77.379959 Support:
3 1 8 11 0 0 474 1860 692 44 -1
4 1 8 11 1 0 474 1860 692 44 -1
5 1 8 11 1 1 474 1869 36 32 90.629700 A.
5 1 8 11 1 2 547 1866 104 36 81.030212 J-125,
5 1 8 11 1 3 665 1865 142 39 96.775848 Request
5 1 8 11 1 4 817 1865 47 31 96.775848 for
5 1 8 11 1 5 873 1860 146 35 96.348213 Terminal
5 1 8 11 1 6 1030 1862 136 36 96.782501 Access,
3 1 8 12 0 0 476 1907 927 40 -1
4 1 8 12 1 0 476 1907 927 40 -1
5 1 8 12 1 1 476 1914 34 30 89.695709 B.
5 1 8 12 1 2 547 1910 106 37 91.710693 J-129,
5 1 8 12 1 3 663 1908 183 33 96.422005 Affirmation
5 1 8 12 1 4 859 1907 182 36 96.742302 Statement,
5 1 8 12 1 5 1399 1937 4 3 29.976053 ;
3 1 8 13 0 0 478 1946 976 45 -1
4 1 8 13 1 0 478 1946 976 45 -1
5 1 8 13 1 1 478 1958 35 30 89.594345 C.
5 1 8 13 1 2 549 1955 137 36 34.168884 CS-+169,
5 1 8 13 1 3 700 1953 128 32 94.856979 Conflict
5 1 8 13 1 4 838 1952 35 31 93.304436 of
5 1 8 13 1 5 883 1947 382 39 27.808739 Interest/Contidentiality
5 1 8 13 1 6 1274 1946 180 37 96.648743 Statement,
3 1 8 14 0 0 441 1994 1853 174 -1
4 1 8 14 1 0 478 1994 788 39 -1
5 1 8 14 1 1 478 2003 35 28 92.290642 D.
5 1 8 14 1 2 549 2000 87 31 96.464775 State
5 1 8 14 1 3 648 2000 35 30 96.663788 of
5 1 8 14 1 4 691 1998 129 32 96.456474 Arizona
5 1 8 14 1 5 831 1997 125 31 95.863396 Access
5 1 8 14 1 6 965 1994 190 39 95.798363 Agreement
5 1 8 14 1 7 1168 1994 98 30 83.514679 Form.
4 1 8 14 2 0 444 2027 1850 57 -1
5 1 8 14 2 1 444 2045 143 39 96.011810 Request
5 1 8 14 2 2 615 2043 54 32 96.586174 the
5 1 8 14 2 3 699 2042 104 31 96.379204 above
5 1 8 14 2 4 832 2037 164 36 93.373497 electronic
5 1 8 14 2 5 1023 2037 99 33 96.559250 forms
5 1 8 14 2 6 1152 2037 77 32 92.766533 from
5 1 8 14 2 7 1257 2036 111 37 92.766533 ADES,
5 1 8 14 2 8 1399 2034 157 39 94.681610 complete
5 1 8 14 2 9 1585 2034 53 30 95.877419 the
5 1 8 14 2 10 1669 2033 106 36 95.887146 forms,
5 1 8 14 2 11 1808 2031 61 32 96.312263 and
5 1 8 14 2 12 1899 2031 81 30 88.360802 send
5 1 8 14 2 13 2013 2027 219 40 82.545525 electronically
5 1 8 14 2 14 2261 2028 33 30 88.721939 to
4 1 8 14 3 0 441 2085 455 44 -1
5 1 8 14 3 1 441 2085 455 44 87.047340 ISAADMIN@AZDES.GOV
4 1 8 14 4 0 442 2120 1211 48 -1
5 1 8 14 4 1 442 2135 94 31 95.662636 Work
5 1 8 14 4 2 546 2133 36 32 88.437691 all
5 1 8 14 4 3 592 2130 125 33 96.066025 ATLAS
5 1 8 14 4 4 729 2136 162 32 95.618126 suspense
5 1 8 14 4 5 903 2129 101 34 95.486984 codes
5 1 8 14 4 6 1013 2127 49 32 96.873917 for
5 1 8 14 4 7 1072 2127 52 32 93.305359 the
5 1 8 14 4 8 1135 2126 142 37 78.283264 county’s
5 1 8 14 4 9 1290 2124 66 32 96.121269 Non
5 1 8 14 4 10 1368 2123 75 33 81.344757 IV-D
5 1 8 14 4 11 1455 2129 98 24 96.886345 cases
5 1 8 14 4 12 1566 2120 87 40 94.624512 daily.
2 1 9 0 0 0 272 2223 510 77 -1
3 1 9 1 0 0 272 2223 510 77 -1
4 1 9 1 1 0 272 2223 510 35 -1
5 1 9 1 1 1 272 2226 61 32 66.396088 5,2,
5 1 9 1 1 2 411 2223 114 32 68.577988 OTHER
5 1 9 1 1 3 534 2225 248 28 95.673706 REQUIREMENTS
4 1 9 1 2 0 409 2264 266 36 -1
5 1 9 1 2 1 409 2268 67 32 95.205376 The
5 1 9 1 2 2 487 2265 89 32 96.731026 Clerk
5 1 9 1 2 3 588 2264 87 33 77.020729 shalt:
2 1 10 0 0 0 307 2313 92 32 -1
3 1 10 1 0 0 307 2313 92 32 -1
4 1 10 1 1 0 307 2313 92 32 -1
5 1 10 1 1 1 307 2313 92 32 73.357605 5.2.1,
2 1 11 0 0 0 309 2492 93 31 -1
3 1 11 1 0 0 309 2492 93 31 -1
4 1 11 1 1 0 309 2492 93 31 -1
5 1 11 1 1 1 309 2492 93 31 95.531815 5.2.2,
2 1 12 0 0 0 310 2712 94 33 -1
3 1 12 1 0 0 310 2712 94 33 -1
4 1 12 1 1 0 310 2712 94 33 -1
5 1 12 1 1 1 310 2712 94 33 70.134666 §.2.3,
2 1 13 0 0 0 313 2847 91 30 -1
3 1 13 1 0 0 313 2847 91 30 -1
4 1 13 1 1 0 313 2847 91 30 -1
5 1 13 1 1 1 313 2847 91 30 87.452248 6.2.4.
2 1 14 0 0 0 445 2292 1856 629 -1
3 1 14 1 0 0 445 2292 1853 228 -1
4 1 14 1 1 0 445 2292 1850 51 -1
5 1 14 1 1 1 445 2310 130 33 96.770599 Provide
5 1 14 1 1 2 591 2310 54 32 95.202599 the
5 1 14 1 1 3 663 2307 102 32 91.196732 Office
5 1 14 1 1 4 781 2306 33 31 96.973824 of
5 1 14 1 1 5 828 2306 54 31 96.969505 the
5 1 14 1 1 6 900 2304 140 39 96.150597 Attorney
5 1 14 1 1 7 1059 2303 135 31 96.585442 General
5 1 14 1 1 8 1215 2309 33 25 95.619370 or
5 1 14 1 1 9 1266 2301 51 32 95.619370 the
5 1 14 1 1 10 1334 2301 97 32 96.399063 Office
5 1 14 1 1 11 1449 2300 34 31 96.946091 of
5 1 14 1 1 12 1497 2307 39 24 96.880219 an
5 1 14 1 1 13 1555 2298 134 33 96.811729 Arizona
5 1 14 1 1 14 1706 2297 122 39 95.875175 County
5 1 14 1 1 15 1842 2297 145 37 87.283249 Attorney
5 1 14 1 1 16 2006 2295 156 38 96.821457 operating
5 1 14 1 1 17 2181 2303 21 22 96.615990 a
5 1 14 1 1 18 2220 2292 75 33 66.239487 IV-D
4 1 14 1 2 0 445 2337 1853 59 -1
5 1 14 1 2 1 445 2361 143 35 96.808052 program
5 1 14 1 2 2 600 2354 69 33 96.672302 with
5 1 14 1 2 3 685 2351 164 31 96.558228 electronic
5 1 14 1 2 4 862 2349 119 33 96.833916 remote
5 1 14 1 2 5 993 2357 122 22 96.709618 access
5 1 14 1 2 6 1127 2348 33 30 74.146408 fo
5 1 14 1 2 7 1173 2348 93 31 96.995834 those
5 1 14 1 2 8 1282 2345 124 33 96.857529 records
5 1 14 1 2 9 1419 2345 152 39 96.902451 pursuant
5 1 14 1 2 10 1582 2345 32 28 96.990105 to
5 1 14 1 2 11 1629 2342 96 31 79.203415 Rules
5 1 14 1 2 12 1740 2340 34 32 96.901146 of
5 1 14 1 2 13 1787 2340 51 32 93.282120 the
5 1 14 1 2 14 1851 2340 158 41 64.421616 Suprerne
5 1 14 1 2 15 2022 2340 93 30 93.070747 Court
5 1 14 1 2 16 2129 2337 108 39 88.002487 123(g)
5 1 14 1 2 17 2249 2339 49 30 97.021072 for
4 1 14 1 3 0 445 2381 1853 51 -1
5 1 14 1 3 1 445 2400 37 32 81.386086 all
5 1 14 1 3 2 502 2399 74 33 64.918098 1V-D
5 1 14 1 3 3 595 2405 83 25 96.742371 case
5 1 14 1 3 4 700 2396 124 31 96.676773 records
5 1 14 1 3 5 844 2396 22 30 93.069984 if
5 1 14 1 3 6 882 2396 51 30 96.856552 the
5 1 14 1 3 7 951 2393 90 33 96.916100 Clerk
5 1 14 1 3 8 1060 2390 164 34 96.441719 maintains
5 1 14 1 3 9 1245 2390 36 33 90.359894 its
5 1 14 1 3 10 1299 2390 84 31 96.928383 court
5 1 14 1 3 11 1401 2388 125 32 96.121819 records
5 1 14 1 3 12 1544 2385 227 41 95.659821 electronically
5 1 14 1 3 13 1793 2387 145 39 96.630493 pursuant
5 1 14 1 3 14 1956 2387 32 30 96.971016 to
5 1 14 1 3 15 2009 2385 51 32 96.959396 the
5 1 14 1 3 16 2079 2384 96 30 96.876457 Rules
5 1 14 1 3 17 2193 2381 35 31 96.953484 of
5 1 14 1 3 18 2241 2381 57 31 96.966362 the
4 1 14 1 4 0 445 2442 325 42 -1
5 1 14 1 4 1 445 2445 155 39 96.623436 Supreme
5 1 14 1 4 2 613 2442 98 32 95.325401 Court
5 1 14 1 4 3 720 2442 50 30 87.222801 94,
4 1 14 1 5 0 447 2486 339 34 -1
5 1 14 1 5 1 447 2489 114 31 95.312721 Minute
5 1 14 1 5 2 572 2487 117 32 63.776024 entries
5 1 14 1 5 3 702 2486 84 31 77.178276 shall:
3 1 14 2 0 0 478 2525 703 40 -1
4 1 14 2 1 0 478 2525 703 40 -1
5 1 14 2 1 1 478 2534 37 31 89.855476 A.
5 1 14 2 1 2 552 2529 123 35 47.066963 Include
5 1 14 2 1 3 685 2529 122 33 96.734329 ATLAS
5 1 14 2 1 4 819 2526 158 36 96.372353 numbers,
5 1 14 2 1 5 991 2526 19 32 94.645424 if
5 1 14 2 1 6 1018 2525 163 33 76.654747 available,
3 1 14 3 0 0 483 2570 600 40 -1
4 1 14 3 1 0 483 2570 600 40 -1
5 1 14 3 1 1 483 2579 32 30 85.475342 B.
5 1 14 3 1 2 553 2577 44 30 96.942398 Be
5 1 14 3 1 3 607 2573 158 34 88.705025 delivered
5 1 14 3 1 4 778 2571 227 39 82.636658 electronically;
5 1 14 3 1 5 1018 2570 65 31 96.130348 and
3 1 14 4 0 0 481 2603 1817 52 -1
4 1 14 4 1 0 481 2603 1817 52 -1
5 1 14 4 1 1 481 2624 35 28 90.041504 C.
5 1 14 4 1 2 553 2621 28 31 0.000000 In
5 1 14 4 1 3 595 2619 76 32 0.000000 IV-D
5 1 14 4 1 4 685 2625 107 30 96.213295 cases,
5 1 14 4 1 5 808 2616 138 32 96.684875 endorse
5 1 14 4 1 6 958 2616 52 30 96.754898 the
5 1 14 4 1 7 1021 2615 103 31 95.484261 Office
5 1 14 4 1 8 1137 2613 33 32 96.984200 of
5 1 14 4 1 9 1179 2613 54 32 96.603943 the
5 1 14 4 1 10 1244 2612 142 39 96.335159 Attorney
5 1 14 4 1 11 1398 2609 134 33 96.872391 General
5 1 14 4 1 12 1544 2618 39 22 96.733604 or
5 1 14 4 1 13 1593 2609 54 31 96.879875 the
5 1 14 4 1 14 1659 2607 102 32 96.592873 Office
5 1 14 4 1 15 1775 2607 34 39 96.157738 pf
5 1 14 4 1 16 1818 2607 51 32 96.157738 the
5 1 14 4 1 17 1883 2607 121 39 96.923721 County
5 1 14 4 1 18 2015 2606 150 39 95.534195 Attorney,
5 1 14 4 1 19 2180 2604 53 33 95.246193 not
5 1 14 4 1 20 2243 2603 55 33 95.450256 the
3 1 14 5 0 0 448 2663 1853 258 -1
4 1 14 5 1 0 481 2663 322 39 -1
5 1 14 5 1 1 481 2664 161 32 83.692459 individual
5 1 14 5 1 2 654 2663 149 39 94.457291 attorney.
4 1 14 5 2 0 448 2691 1850 54 -1
5 1 14 5 2 1 448 2711 29 34 94.864822 In
5 1 14 5 2 2 490 2709 76 32 94.864822 both
5 1 14 5 2 3 589 2709 76 32 84.439537 IV-D
5 1 14 5 2 4 676 2708 65 31 92.799675 and
5 1 14 5 2 5 754 2706 119 32 54.367844 Non-lV
5 1 14 5 2 6 885 2706 24 30 93.214500 D
5 1 14 5 2 7 922 2711 107 30 96.042747 cases,
5 1 14 5 2 8 1042 2703 31 32 96.526360 in
5 1 14 5 2 9 1086 2702 198 30 96.381241 accordance
5 1 14 5 2 10 1294 2700 67 32 93.148849 with
5 1 14 5 2 11 1372 2700 110 32 47.140572 A.R.S.
5 1 14 5 2 12 1494 2699 20 39 89.607956 §
5 1 14 5 2 13 1525 2697 182 39 61.568817 25-504(E),
5 1 14 5 2 14 1724 2697 72 32 95.422417 mail
5 1 14 5 2 15 1806 2703 33 24 96.819611 or
5 1 14 5 2 16 1850 2696 52 31 96.954231 fax
5 1 14 5 2 17 1913 2696 36 30 92.536285 all
5 1 14 5 2 18 1964 2694 123 33 95.945053 Income
5 1 14 5 2 19 2099 2691 199 41 96.384605 Withholding
4 1 14 5 3 0 448 2739 1852 53 -1
5 1 14 5 3 1 448 2754 118 32 96.523697 Orders
5 1 14 5 3 2 577 2751 115 41 96.471642 signed
5 1 14 5 3 3 708 2751 39 38 96.471642 by
5 1 14 5 3 4 760 2751 50 32 96.779694 the
5 1 14 5 3 5 823 2750 95 31 96.426910 Court
5 1 14 5 3 6 930 2756 81 31 95.747299 upon
5 1 14 5 3 7 1025 2747 88 39 96.796608 entry
5 1 14 5 3 8 1126 2747 34 30 96.796608 of
5 1 14 5 3 9 1170 2754 21 23 96.919395 a
5 1 14 5 3 10 1206 2753 71 24 96.820358 new
5 1 14 5 3 11 1288 2753 34 24 96.736732 or
5 1 14 5 3 12 1333 2742 142 35 94.979202 modified
5 1 14 5 3 13 1488 2742 78 32 94.979202 child
5 1 14 5 3 14 1581 2741 129 39 96.720650 support
5 1 14 5 3 15 1722 2741 93 31 96.866562 order
5 1 14 5 3 16 1827 2748 33 21 96.811111 or
5 1 14 5 3 17 1874 2748 40 23 96.876656 an
5 1 14 5 3 18 1926 2739 102 30 96.824303 Order
5 1 14 5 3 19 2039 2739 30 30 96.054420 to
5 1 14 5 3 20 2084 2739 76 38 96.746056 Stop
5 1 14 5 3 21 2175 2739 125 29 95.987244 Income
4 1 14 5 4 0 448 2778 1667 59 -1
5 1 14 5 4 1 448 2796 201 41 96.236694 Withholding
5 1 14 5 4 2 661 2795 147 40 96.601044 promptly
5 1 14 5 4 3 819 2793 113 32 95.879433 unless
5 1 14 5 4 4 942 2793 53 30 96.221321 the
5 1 14 5 4 5 1005 2792 171 31 92.113068 document
5 1 14 5 4 6 1186 2790 88 32 96.390450 must
5 1 14 5 4 7 1282 2789 40 31 96.827553 be
5 1 14 5 4 8 1334 2787 141 33 96.681046 returned
5 1 14 5 4 9 1486 2787 29 32 96.913765 to
5 1 14 5 4 10 1528 2786 55 33 96.913765 the
5 1 14 5 4 11 1593 2784 129 33 95.757660 Judicial
5 1 14 5 4 12 1734 2784 114 32 96.387932 Officer
5 1 14 5 4 13 1859 2784 45 32 96.209465 for
5 1 14 5 4 14 1914 2778 201 51 94.601883 clarification.
4 1 14 5 5 0 450 2826 1850 51 -1
5 1 14 5 5 1 450 2844 125 32 94.460228 Income
5 1 14 5 5 2 585 2840 203 37 96.299667 Withholding
5 1 14 5 5 3 801 2838 117 33 96.983734 Orders
5 1 14 5 5 4 931 2837 175 37 94.264565 containing
5 1 14 5 5 5 1119 2835 51 32 96.911972 the
5 1 14 5 5 6 1184 2832 105 33 96.470528 Social
5 1 14 5 5 7 1302 2832 135 39 94.284767 Security
5 1 14 5 5 8 1450 2831 138 33 96.806931 Number
5 1 14 5 5 9 1599 2829 36 32 96.717972 of
5 1 14 5 5 10 1645 2829 53 32 93.300507 the
5 1 14 5 5 11 1710 2828 126 39 93.142998 Obligor
5 1 14 5 5 12 1847 2828 75 33 74.098236 shall
5 1 14 5 5 13 1937 2828 55 31 96.969879 not
5 1 14 5 5 14 2004 2828 42 30 96.969879 be
5 1 14 5 5 15 2058 2826 186 32 96.017189 transmitted
5 1 14 5 5 16 2259 2826 41 36 97.004265 by
4 1 14 5 6 0 450 2870 1851 51 -1
5 1 14 5 6 1 450 2885 164 36 79.224503 electronic
5 1 14 5 6 2 631 2885 70 33 83.349670 mail
5 1 14 5 6 3 720 2885 27 31 95.489609 in
5 1 14 5 6 4 763 2883 197 32 96.920174 accordance
5 1 14 5 6 5 977 2883 30 29 92.619080 to
5 1 14 5 6 6 1021 2880 112 32 89.551346 A.R.S.
5 1 14 5 6 7 1152 2880 20 38 92.647881 §
5 1 14 5 6 8 1189 2876 247 40 71.261375 44-1373(A)(3),
5 1 14 5 6 9 1455 2876 109 31 94.155518 unless
5 1 14 5 6 10 1582 2873 190 33 93.826965 transmitted
5 1 14 5 6 11 1793 2874 87 38 96.123680 using
5 1 14 5 6 12 1898 2882 19 21 96.580818 a
5 1 14 5 6 13 1932 2879 117 24 96.580818 secure
5 1 14 5 6 14 2064 2870 183 33 79.894920 connection
5 1 14 5 6 15 2264 2876 37 24 95.644501 or
2 1 15 0 0 0 450 2930 1851 96 -1
3 1 15 1 0 0 450 2930 1851 96 -1
4 1 15 1 1 0 450 2930 186 40 -1
5 1 15 1 1 1 450 2930 186 40 95.347649 encryption.
4 1 15 1 2 0 2108 2990 193 36 -1
5 1 15 1 2 1 2108 2990 78 36 96.582634 Page
5 1 15 1 2 2 2198 2990 16 30 96.094917 3
5 1 15 1 2 3 2225 2991 30 29 96.094917 of
5 1 15 1 2 4 2261 2990 40 27 93.951195 20
2 1 16 0 0 0 2543 828 7 82 -1
3 1 16 1 0 0 2543 828 7 82 -1
4 1 16 1 1 0 2543 828 7 82 -1
5 1 16 1 1 1 2543 828 7 82 95.000000
2 1 17 0 0 0 2453 166 29 3034 -1
3 1 17 1 0 0 2453 166 29 3034 -1
4 1 17 1 1 0 2453 166 29 3034 -1
5 1 17 1 1 1 2453 166 29 3034 95.000000
5.1.14.
5.1.15.
6.2.5. Make all appropriate ATLAS entries reflecting entry of support orders, orders of assignment or income
withholding orders promptly. Guidelines for what constitutes appropriate entries can be found in Exhibit A,
which is attached hereto and incorporated herein by reference.
5.2.6. Shall not delete unpaid Clearinghouse fees in a case unless there is an explicit court order waiving the fees.
5.2.7. Provide information regarding the dates and case numbers of adoptions and termination of parental rights as
requested by ADES, County Attorneys or the Attorney General's Office so support orders may be stopped or
modified,
5.3. GUSTOMER SERVICE
The Clerk shalt:
6.3.1. Respond to ADES' inquiries concerning support cases within two (2) business days.
5.3.2. Provide customer service for Non IV-D cases and access during regular business hours of 8:00 A.M, to 5:00
P.M., Monday through Friday, excluding holidays. Customer Service Includes answerlng telephone calls,
serving walk-in customers, and returning telephone calls within one business day. The Clerk is solely
responsible for customer service inquiries on its county caseload. These inquiries include questions
regarding payments and distribution, debt balances, debt adjustments, and case status,
§,3,3. Shail not direct customer telephone calls regarding Non- !V-D inquiries to ADES’ staff. Clerk staff shall,
within two (2)-business days, email the appropriate ADES emall address with a request for information,
§,3.4, Send email addresses for these Inquiries to Clerk staff upon the execution of this Agreement.
5.3.6, Provide fo ADES names of Non- IV-D customer service representatives to whom Inquiries and complaints
can be directed for investigation and response to ADES upon execution of this Agreement.
6.3.6. Upan request by ADES, its agent the Office of the Attorney General operating a IV-D prograrn, the Clerk
shall provide, free of charge, copies of case records [as defined by Rules of the Supreme Court
423(b)(16)(B)],, Records shall be delivered or made accessible by mail, facsimile, or an electronically
scanned format, to the requesting party within five (5) calendar days of the request.
5.3.7, Provide certified copies of court documents to ADES within fifteen (15) calendar days of the request at no
charge when required. Copies requested by parties shall be provided in the same fimely manner but the
Court may charge for copies as permitted by law.
5.3.8, Update ATLAS upon receipt of new information by close of business promptly, Changes include, but are not
limited to, names, addresses of the parties, telephone numbers, placement of the domestic violence _
indicator (NDI), job information, sources of income, and Social Securlty numbers. The Clerk shall add alert
codes to the Case Activity List (CAAL) In ATLAS, upon processing all orders in Non-IV cases.
6.3.9. Requests to open cases in which a Notice of Change in Status is received shall be processed promptly.
5.3.10. Notify employers in writing, within flve (8) business days, of the change in the case number. When the
status of the case is changed from IV-D to Non IV-D. This Is to ensure proper payment credit on an Income
Withholding Order.
§,3.11. Review these cases within thirty (80) business days of receipt of the report.
5.3.12. Submit a Cost Allocation Plan for the state fiscal year, and a Budget that includes incentive plan, Job
descriptions, projected Clerk expenditures for child support activities for review and approval. Thereafter, lhe
Cost Allocation Plan and Budget shall be submitted, no later than, July 31” annually.
5.3.13. Submit updated Budget, within five (5) business days for review and approval, upon the Clerk's
determination that the Clerk is going to exceed ADES approved budget amount
5.4. {solate Incentive payments received from other funding and dedicate the use of such payments solely for the
enhancement of the Clerk’s IV-D program. Expenditure of incentive payments must follow the requirements of
Section 7309 of the Deficit Reduction Act of 2005.
5.5, Shall pay ADES In an amount equal to the amount of the disallowance, if ADES conducts a financial audit and
disallows expenses reimbursed under this agreement.
5.6. Shall pay ADES an amount equal to any disallowance of expenses within 30 calendar days, If the Federal
Office of Child Support Enforcement conducts a financial audit and disallows the Clerk expenses already
reimbursed by ADES.
ADES wilt:
5.7. GENERAL REQUIREMENTS
Respond to email inquirles within two (2) business days
5.7.1, Be responsible for the removal of the “R” narrative on IV-D cases, :
5.7.2. Relmburse the Clerk for costs incurred in the delivery of contract services during the term of this Agreement.
5.7.3, Under this Agreement, the relmbursement rate shall be at the applicable amount established by the federal
government In accordance with 42 U.S. Code, Section 655(a){2).
Page 4 of 20
5.7.4. Review and approve incentives based upon the methodology set forth in ADES' current Incentive policy that
is incorporated by reference into this Agreement.
;
A. The incentive system for State child support programs measure State performance In five (5) areas:
4. Establishment of paternities;
2, Establishment of child support orders;
3. Collections on current child support due;
4. Collection on past child support due (arrears); and
5, Cost effectiveness.
6. Pay to the Clerk, as required by law, a proportionate share of incentives at the end of each
quarter,
7. All planned Incentive expenditures shall be reviewed and must be approved by ADES.
5.8. TRAINING:
ADES wil:
5.8.1. Provide ATLAS training to the Clerk of the Court staff sufficlent for the staff to comply with their duties under
this agreement. Within thirty (30) calendar days of contract award, the Clerk shall designate two (2) Subject
Matter Experts (SME} to be trained by ADES. Thereafter it shall be the responsibility of the SME in the Clerk
of the Gourt Office to train new personnel, as necessary, to become a SME.
5.8.2, Other training may be Identified and the price(s) shall be mutually agreed upon by the parties.
5.8.3, Provide one-time instruction to the designated employees from the Clerk at no charge. All training shail be
conducted in the Phoenix metro area. For Clerk staff who must travel, costs will be relmbursed by
submitting a clalm on the Certified Public Expenditure Statement (CPES) for travel, lodging, and per diem, if
necessary. Reimbursement shall be in accordance with the State of Arizona Accounting Manual.
6.0 COMPENSATION FOR SERVICE
Actual, allowable expenditures shall be determined in accordance with provisions of this agreement, and CFR
Title 45, Subtitle B, Chapter [Il, Part 304,
6.2. Payment will be issued within 30 business days from receipt of a correct CPES submittal; defined at 7.2.
6.3. ‘The services set forth in this Agreement may be reimbursed only for matters brought In IV-D cases, and on
behalf of a judicial officer who is not a Judge of fhe court. Clerical, secretarial, court reporter staffing and court
interpreters shall be allowable expenses for a judicial officer or referee. This may-include clerical time for the
completion of minute entries mandated by court rule.
6.4. Under this agreement, the reimbursement rate shall be at the applicable amount established by the federal
government in accordance with 42 U.S, Cade, Section 656(a)(2).
7.0 REPORTING REQUIREMENTS
Pravide to ADES the following reports referencing the contract number:
72. Submit monthly CPES and IV-D Compensation Form, Exhibit A with — sufficient supporting expense
documentation Including employee time and réecelpts for purchases.
7.3. _ Submit quarterly Sub Recipient Incentive Report, Exhibit B by the 5" business day of the quarter end.
TA, The Clerk shall subrnit ail raports electronically to:
Arizona Department of Economic Security
Division of Child Support Services
Via email to: DGSSIGACIaims@azdes.gov
7.8, Other reports may be required by ADES through the Contract term.
8.0 PAYMENT REQUIREMENTS
8.1. The Clerk shall submit monthly a CPES and IV-D Compensation Form, Exhibit A, for costs incurred in tha
delivery of Contracted Services.
8.2. The Clerk shall submit supporting expense documents each month with the CPES to support the expenses
each manth.
8.3, CPES and IV-D Compensation Form shall be submitted no later than the 30th" day after the end of the
previous month in which services were provided and sent electronically to:
Arizona Department of Economic Security
Division of Child Support Services
Via email to: DCSSIGAClaims@azdes.qov
Page 5 of 20
8,4, Per Federal Register at 65 FR 82178, ADES, Federal auditors, central and regional office shall have the right
to monitor the Clerk’s compliance with reinvestment requirement. Non-cormpliance could result in
disallowances of incentive amounts equal to the amount of funds supplanted, including closed cases with
State owned monies. Per Federal Register 65 FR 821678, non-compliance could result in disallowances of
incentive amount equal to the amount of funds supplanted, including closed cases with state owed monies.
8.5, Payments shail be pald via ACH by using the ACH process. Instructions and downloadable forms are found at
htips://ga0.az.qov/sites/defautt/flles/GAO-618%20ACH%20Vendar%20Autharization%20030215-S%26S. pdf
9.0 NoTicEs
All notices to the Clerk regarding this agreement shall be sent to the following address
Glerk of the Superior Court of Maricopa County
ATTN: Ms. Kathleen McClaning, Deputy Director
Downtown Justice Center
Clerk of the Court :
620 West Jackson, Suite 3017
Phoenix, AZ 85003
9,2. All notices fo ADES regarding this agreement shall be sent electronically to:
Arizona Department of Economie Security
Division of Child Support Services
Via email to: DCSS{GACIalms@azdes.gov
18.0 EXTENSION
10.1, This Agreement may be extended through a written amendment by mutual Agreement of the parties, but in no
event for a total period that exceeds ten (10) years..
TERMINATION
This agreement may be ferminated by mutual agreement of the parties at any time during the term of this
agreement.
Fach party shall have the right to terminate this agreement by written notice of termination to the other party at
least thirty (30) days prior to the effective date of sald termination. The other party shall provide written
acknowledgement of sald termination.
12.0 AMENDMENTS
12.1. This Agreement may be amended at any time by mutual written agreement. No agent, employee or other
representative of elther Party is empowered to alter any of the terms of the Agreement, unless amended in
writing and signed by the authorized representative of the respactive Parties.
12.2, Either party shall give written notice to the other party of any non-material alteration that affects the provisions
of this Agreement. Non-material alterations that do not require a written amendment are as follows:
12.3. Change of telephone number;
12.4, Change in authorized signatory; and/or
42.5, Change In the name and/or address of the person to whom notices are to be sent.
13.0 NIANNER OF FINANCING
13.1. These services are financed by an annual grant from the Department of Health and Human Services,
Administration for Children and Families.
14.0 DISPOSITION OF PROPERTY
44.1. If the Clerk is authorized to purchase equipment, it Is to be Itemized In the contract for utilization In the delivery
of contract services. {f equipment is purchased as authorized by this contract, the Clerk shall maintain
complete and up-fo-date inventory records for all Equipment purchased hereunder. Equipment specifically
designated within this contract, to be purchased in whole or part with ADES funds, shall be reported in
accordance with Depariment inventory policies and procedures.
14,2, ADES shail retain an equitable Interest equal to the purchase price paid, or fair estimate or appraisal of current
market value, whichever is greater, in all Equipment purchased under this contract. ADES shall be included
as a co-Insured on any insurance policy that covers Equipment purchased under this contract.
Page 6 of 20
14.3, The Clerk shall not dispose of any Equipment purchased under this contract without the prior written consent
of ADES during and after the contract term. Such consent, if given, may include direction as fo the means of
disposition and the utilization of proceeds, including any necessary adjustments to the contract.
_
14.4, Upon termination of this contract, any Equipment purchased under this contract shall be disposed of as
directed by ADES and, if sold, ADES shall be compensated in the amount of its equitable interest.
14.5, Under a fixed price contract, Section 13.1 through 13.4 do rot apply unless specifically required by federal or
state law.
15.0 APPLICABLE LAW
15.1. This Agreement shall be governed and interpreted by the laws of the State of Arizona. The materials and
services supplied under this Agreement shall comply with all applicable Federal, State and Jocal laws, and
each Party shall maintain all applicable licenses and permit requirements.
16.0 ARBITRATION
16.1. The Parties to this Agreement agree to resolve all disputes arising out of or relating to this Agreement through
arbitration, after exhausting applicable administrative review, to the extent required by AR.S.§§ 12-1618(B)
and 12-133, except as may be required by other applicable statutes.
17.0 AUDIT
17.1. in accordance with A.R.S. § 35-214, each Party shall retaln and shall contractually require each subcontractor
to retain all data, books and other records ("records") relating to this Agreement for a period of five (5) years
after the completion of the Agreement except if subject to Health insurance Portability & Accountabillty Act
which Is six (6) years from the date of final payment. All records maintained by a Party shail be subject to
inspection and audit by the State at reasonable times, Upon request of a Party, the other Party shall produce
the original of any or all such records. .
18.0 CONFLICT OF INTEREST
48.4. In accordance with A.R.S, § 38-511, the State may within three years after execution terminate the
Agreement, without penalty or further obligation, if any person significantly involved In initiating, negotiating,
securing, drafting or creating the Agreement on behalf of elther party, at any time while the Agreement is In
effect, becomes an employee or agent of any other party to the Agreement In any capacily or a consultant to
any other party to the Agreement with respect to the matter of the Agreement.
19.0 E-VERIFY
19.1. in accordance with A.R.S. § 41-4401, each Party warrants compliance with all Federal immigration laws and
regulations relating to employees and warrants its compliance with A.R.S. § 23-214, Subsection A.
20.0 INDEMNIFICATION: ;
Each party {as Indemnitor) agrees to defend, indemnify, and hold harmless the other party (as Indemnitee)
from and against any and all claims, Josses, liability, costs, or expenses (including reasonable attorney's fees)
(hereinafter collectively referred to as Clalms) arising out of bodily injury of any person (including death) or
property damage, but only fo the extent that such Claims which result in vicarlous/derivative liability to the
Inderonitee are caused by the act, omission, negligence, misconduct, or other fault of the Indermniter, its
officers, officials, agents, employees, or volunteers. The State of Arizona, Department of Economic Security Is
self-insured per A.R.S, 41-621.
in addition, should Maricopa Clerk of Court utilize a contractor(s) and subcontractor(s) the indemnification
clause between Maricopa County Clerk of Court and its contractor(s) and subcontractor(s) shall Include fhe
following: . :
To the fullest extent permitted by law, Contractor shali defend, indemnify, and hold harmless the Maricopa
County Clerk of Court and the State of Arizona, and any jurisdiction or agency Issuing any permits for any
work arising out of this Agreement, and its departments, agencies, boards, commnissions, universities, officers,
officials, agents, and employees (hereinafter referred to as Indernnitee”)
5 1 25 2 4 10 1646 2745 78 30 96.905411 from
5 1 25 2 4 11 1737 2742 63 33 96.659943 and
5 1 25 2 4 12 1811 2742 127 39 96.769264 against
5 1 25 2 4 13 1949 2748 58 33 96.816994 any
5 1 25 2 4 14 2019 2741 62 33 96.589539 and
5 1 25 2 4 15 2094 2741 41 31 92.595207 all
5 1 25 2 4 16 2145 2741 116 37 95.976921 claims,
4 1 25 2 5 0 402 2786 1805 49 -1
5 1 25 2 5 1 402 2798 129 37 93.305153 actions,
5 1 25 2 5 2 547 2795 151 37 79.776505 liabilittes,
5 1 25 2 5 3 711 2795 167 37 95.566887 damages,
5 1 25 2 5 4 891 2793 117 36 96.753159 losses,
5 1 25 2 5 5 1023 2801 34 24 96.928169 or
5 1 25 2 5 6 1066 2798 167 33 96.286362 expenses
5 1 25 2 5 7 1245 2789 162 42 92.173668 (including
5 1 25 2 5 8 1419 2790 84 30 95.074120 court
5 1 25 2 5 9 1513 2790 100 35 96.653046 costs,
5 1 25 2 5 10 1626 2786 165 40 94.223549 attorneys’
5 1 25 2 5 11 1805 2787 79 36 95.191101 fees,
5 1 25 2 5 12 1898 2787 64 32 96.242249 and
5 1 25 2 5 13 1974 2786 87 31 96.537277 costs
5 1 25 2 5 14 2073 2786 35 31 93.280373 of
5 1 25 2 5 15 2118 2786 89 31 83.883759 clalm
4 1 25 2 6 0 402 2829 1853 54 -1
5 1 25 2 6 1 402 2841 193 42 96.656281 processing,
5 1 25 2 6 2 610 2840 212 39 80.062965 investigation
5 1 25 2 6 3 835 2837 61 33 96.652634 and
5 1 25 2 6 4 909 2837 153 39 95.665337 litigation)
5 1 25 2 6 5 1074 2835 198 39 88.039421 (hereinafter
5 1 25 2 6 6 1282 2834 133 31 96.375023 referred
5 1 25 2 6 7 1426 2834 31 31 96.605057 to
5 1 25 2 6 8 1470 2841 39 24 95.206490 as
5 1 25 2 6 9 1519 2832 157 39 22.668766 Claims’)
5 1 25 2 6 10 1688 2831 46 33 96.863686 for
5 1 25 2 6 11 1745 2831 99 39 96.846985 bodily
5 1 25 2 6 12 1856 2831 94 40 96.672188 Injury
5 1 25 2 6 13 1961 2838 32 23 96.590210 or
5 1 25 2 6 14 2004 2829 149 41 96.516983 personal
5 1 25 2 6 15 2165 2829 90 41 95.460564 injury
4 1 25 2 7 0 403 2873 1783 54 -1
5 1 25 2 7 1 403 2885 163 42 95.507126 {including
5 1 25 2 7 2 577 2885 116 39 96.891251 death),
5 1 25 2 7 3 709 2891 35 25 96.835625 or
5 1 25 2 7 4 754 2885 68 31 85.756973 toss
5 1 25 2 7 5 832 2889 38 26 96.843498 or
5 1 25 2 7 6 877 2883 139 36 96.781517 damage
5 1 25 2 7 7 1027 2883 31 29 96.953094 to
5 1 25 2 7 8 1068 2880 138 38 96.549339 tangible
5 1 25 2 7 9 1218 2888 33 24 96.961861 or
5 1 25 2 7 10 1261 2879 164 37 82.223167 intangible
5 1 25 2 7 11 1435 2879 140 39 96.906120 property
5 1 25 2 7 12 1586 2876 133 37 96.356941 caused,
5 1 25 2 7 13 1734 2883 35 24 96.987061 or
5 1 25 2 7 14 1781 2876 120 39 96.520355 alleged
5 1 25 2 7 15 1916 2876 31 31 95.253006 to
5 1 25 2 7 16 1959 2876 41 30 96.958595 be
5 1 25 2 7 17 2010 2874 137 36 96.465698 caused,
5 1 25 2 7 18 2159 2873 27 33 96.559860 in
4 1 25 2 8 0 402 2918 1844 51 -1
5 1 25 2 8 1 402 2931 99 32 95.669075 whole
5 1 25 2 8 2 513 2937 36 26 96.486885 or
5 1 25 2 8 3 560 2930 27 33 92.479584 In
5 1 25 2 8 4 600 2930 74 39 96.908257 part,
5 1 25 2 8 5 687 2930 41 37 96.321304 by
5 1 25 2 8 6 738 2928 54 32 96.816246 the
5 1 25 2 8 7 804 2927 153 39 91.493774 negligent
5 1 25 2 8 8 967 2933 38 25 93.462173 or
5 1 25 2 8 9 1014 2924 95 33 60.066200 willful
5 1 25 2 8 10 1122 2925 69 32 93.182304 acts
5 1 25 2 8 11 1203 2931 35 26 96.780579 or
5 1 25 2 8 12 1246 2924 170 31 92.690529 omissions
5 1 25 2 8 13 1426 2922 35 33 96.969162 of
5 1 25 2 8 14 1470 2922 51 33 96.682823 the
5 1 25 2 8 15 1533 2921 174 33 93.206718 contractor
5 1 25 2 8 16 1716 2927 35 25 93.027153 or
5 1 25 2 8 17 1761 2927 63 34 96.683037 any
5 1 25 2 8 18 1835 2921 31 30 96.266861 of
5 1 25 2 8 19 1878 2919 55 32 97.010460 the
5 1 25 2 8 20 1944 2919 153 38 96.651184 directors,
5 1 25 2 8 21 2112 2918 134 37 95.592880 officers,
2 1 26 0 0 0 2093 2994 195 35 -1
3 1 26 1 0 0 2093 2994 195 35 -1
4 1 26 1 1 0 2093 2994 195 35 -1
5 1 26 1 1 1 2093 2996 83 33 96.386482 Page
5 1 26 1 1 2 2187 2994 17 27 96.364510 7
5 1 26 1 1 3 2213 2994 34 27 96.031906 of
5 1 26 1 1 4 2252 2994 36 27 95.874420 20
2 1 27 0 0 0 2546 87 2 760 -1
3 1 27 1 0 0 2546 87 2 760 -1
4 1 27 1 1 0 2546 87 2 760 -1
5 1 27 1 1 1 2546 87 2 760 95.000000
2 1 28 0 0 0 2543 911 7 74 -1
3 1 28 1 0 0 2543 911 7 74 -1
4 1 28 1 1 0 2543 911 7 74 -1
5 1 28 1 1 1 2543 911 7 74 95.000000
2 1 29 0 0 0 2456 168 11 3036 -1
3 1 29 1 0 0 2456 168 11 3036 -1
4 1 29 1 1 0 2456 168 11 3036 -1
5 1 29 1 1 1 2456 168 11 3036 95.000000
agents, or employees or subcontractors of such contractor, This indemnity includes any clalm or amount
arising out of or recovered under the Workers’ Compensation Law or arising out of the failure of such
contractor to conform to any federal, state or local law, statute, ordinance, rule, regulation or court decree. Ikis
the specific intention of the parties that the Inderunitee shall, in all instances, except for Claims arising solely
from the negligent or willful acts or omissions of the Indemnitee, be indemnified by such contractor from and
against any and ail claims. Itis agreed that such contractor will be responsible for primary loss investigation,
defense and judgment costs where this indemnification is applicable. Additionally on all applicable insurance
policies, contractor and its subcontractors shall name the State of Arizona, and its departments, agencies,
boards, commissions, unlversities, officers, officials, agents, and employees as an additional insured and also
include a waiver of subrogation in favor of the State.
20,1. INSURANCE REQUIREMENTS FOR GOVERNMENTAL PARTIES TO AN IGA
.* None
20.2. INSURANCE REQUIREMENTS FOR ANY GONTRACTORS USED BY A PARTY TO THE INTERGOVERNMENTAL AGREEMENT
(Note: this applies only to Contractors used by a governmental entily, not fo the governmental entity itself.)
The insurance requirements herein are minimum requirements and in no way limit the indemnity covenants
contained {n the Intergovernmental Agreement. The State of Arizona in no way warrants that the minimum
liralts contained herein are sufficient to protect the governmental entity or Contractor from Ilabilitles that might
arise out of the performance of the work under this Contract by the Contractor, his agents, representatives,
employees or subcontractors, and Contractor and the governmental entity are free to purchase additional
insurance.
20.3. Minimum SCoPE AND Limits OF INSURANCE
Contractor shall provide coverage with limits of liability not less than those stated below.
90.3.1. Commercial General Liability - Occurrence Form
Policy shall include bodily injury, property damage, and broad form contractual liability coverage.
*« General Aggregate $2,000,000
e Products Completed Operations Aggregate $1,000,000
» Personal and Advertising Injury $4,000,000
e Damage to Rented Premises $ 60,000
» Each Occurrence $7,000,000
i} The policy shall be endorsed, as required by this written agreement, to include the State of
Arizona, and its departments, agencies, boards, commissions, universities, officers, officials,
agents, and employees as additional insureds with respect to liability arising out of the activities
performed by or on behalf of the Contractor.
ii.) Policy shall contain a waiver of subrogation endorsement, as required by this written agreement,
in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities,
officers, officials, agents, and employees for losses arising from work performed by or on behalf of
‘
the Contractor.
(Note that the other governmental entity(ies) is/are also required to be additional insured(s) and
they should supply the Contractor with their own list of persons to be insured.)
20.3.2, Business Automobile Liabtitty
Bodily Injury and Property Damage for any owned, hired, and/or non-owned automobiles used in the
performance of this Contract.
* Combined Single Limit (CSL) $1,060,000
1.) Policy shall be endorsed, as required by this written agreement, fo include the State of Arizona,
and {fs departments, agencies, boards, commissions, unlversities, officers, officials, agents, and
employees as additional insureds with respect to Ilability arising out of the activities performed by,
or on behalf of, the Contractor Involving automobiles owned, hired and/or non-owned by the
Contractor. .
ii.) Policy shall contain a walver of subrogation endorsement as required by this written agreement in
favor of the State of Arizona, and its departments, agencies, boards, commissions, universities,
Page 8 of 20
officers, officials, agents, and employees for losses arising from work performed by or on behalf of
the Contractor.
(Note that the other governmental entity(ies) is/are also required to be additional insured{s) and
they should stipply the Contractor with their own list of persons to be insured.)
20.3.3. Workers’ Compensation and Employers’ Liability
Workers’ Compensation Statutory
Employers’ Liability
» Each Accident $1,000,000
e Disease ~ Each Employee $1,000,000
e Disease —Palicy Limit $4,000,000
i.) Policy shail contain a waiver of subrogation endorsement, as required by this written agreement,
in favor of the State of Arizona, and its departments, agencies, boards, commissions, universities,
officers, officials, agents, and employees for losses arising from work performed by or on behalf of
fhe Contractor.
ji.) This requirement shall not apply to each Contractor or subcontractor that is exempt under A.R.S. §
23-901, and when such Contractor or subcontractor executes the appropriate walver form (Sole
Proprietor or Indepandent Contractor).
20.4, ADDITIONAL INSURANCE REQUIREMENTS
The policies shall include, or be endorsed to Include, as required by this written agreement, the following
provisions:
20.4.1. The Contractors policies, as applicable, shall stipulate that the Insurance afforded the Contractor shall be
primary and that any insurance carried by the Department, its agents, officials, employees or the State of
Arizona shall be excess and not contributory insurance, as provided by A.R.S. § 41-621 (E).
20.4.2. Insurance provided by the Contractor shal) not limit the Contractor's liability assumed under the
indemnification provisions of this Contract.
20.5. NOTICE OF GANCELLATION
Applicable fo all insurance policies required within the Insurance Requirements of this Contract, Contractor's
insurance shall not be permitted to expire, be suspended, be canceled, or be materially changed for any
reason without thirly (30) days prior written notice fo the State of Arizona. Within two (2) business days of
recelpt, Contractor must provide notice to the State of Arizona if they recelve nolice of a policy that has been
or will be suspended, canceled, materially changed for any reason, has expired, or will be expiring. Such
notice shall be sent directly to the Department and shall be mailed, emailed, hand delivered or sent by
facsimile transmission to (State Representative’s Name, Address & Fax Number).
20.8. ACCEPTABILITY OF INSURERS
Contractor's Insurance shall be placed with companies licensed in the State of Arizona or hold approved non-
admitted status on the Arizona Department of Insurance List of Qualified Unauthorized Insurers. Insurers shall
have an A.M.
5 1 7 1 4 4 673 2163 86 36 89.141281 Best’
5 1 7 1 4 5 775 2166 90 39 96.610939 rating
5 1 7 1 4 6 882 2166 36 32 96.610939 of
5 1 7 1 4 7 931 2166 52 32 96.322090 not
5 1 7 1 4 8 999 2166 69 30 90.658356 less
5 1 7 1 4 9 1086 2163 71 32 93.173592 than
5 1 7 1 4 10 1174 2163 40 32 92.471672 A-
5 1 7 1 4 11 1227 2163 56 30 85.675491 Vil.
5 1 7 1 4 12 1298 2162 67 31 96.398003 The
5 1 7 1 4 13 1381 2160 88 32 96.989288 State
5 1 7 1 4 14 1485 2160 33 32 96.928902 of
5 1 7 1 4 15 1530 2159 134 33 85.233498 Arizona
5 1 7 1 4 16 1681 2159 25 31 92.803329 in
5 1 7 1 4 17 1724 2165 42 25 96.640030 no
5 1 7 1 4 18 1781 2165 67 31 96.918533 way
5 1 7 1 4 19 1863 2157 147 32 96.391670 warrants
5 1 7 1 4 20 2025 2156 66 30 95.179405 that
5 1 7 1 4 21 2108 2156 55 30 96.996086 the
5 1 7 1 4 22 2178 2154 117 32 92.231445 above-
4 1 7 1 5 0 405 2201 1746 54 -1
5 1 7 1 5 1 405 2214 143 41 96.015831 required
5 1 7 1 5 2 562 2213 152 33 95.110023 minimum
5 1 7 1 5 3 727 2213 116 31 95.110023 insurer
5 1 7 1 5 4 853 2210 93 39 95.416183 rating
5 1 7 1 5 5 960 2210 24 30 93.285248 is
5 1 7 1 5 6 996 2208 159 33 90.736855 sufficlent
5 1 7 1 5 7 1164 2208 30 32 96.860657 to
5 1 7 1 5 8 1212 2208 113 39 95.629562 protect
5 1 7 1 5 9 1340 2207 45 30 96.905930 the
5 1 7 1 5 10 1398 2205 180 30 92.915756 Contractor
5 1 7 1 5 11 1587 2204 78 30 96.373421 from
5 1 7 1 5 12 1680 2201 141 40 96.581383 potential
5 1 7 1 5 13 1833 2201 117 31 95.719788 insurer
5 1 7 1 5 14 1959 2201 192 37 95.719788 insolvency.
2 1 8 0 0 0 264 2301 2039 620 -1
3 1 8 1 0 0 264 2301 1986 173 -1
4 1 8 1 1 0 264 2301 606 36 -1
5 1 8 1 1 1 264 2307 83 30 91.173149 20.7.
5 1 8 1 1 2 403 2306 227 30 78.385269 VERIFICATION
5 1 8 1 1 3 642 2307 41 24 96.759163 OF
5 1 8 1 1 4 693 2301 177 30 79.720619 COVERAGE
4 1 8 1 2 0 406 2331 1819 50 -1
5 1 8 1 2 1 406 2348 185 33 96.352188 Contractor
5 1 8 1 2 2 600 2346 78 32 94.815063 shail
5 1 8 1 2 3 689 2343 113 33 92.780235 furnish
5 1 8 1 2 4 814 2343 52 32 96.860924 the
5 1 8 1 2 5 876 2343 90 30 96.922089 State
5 1 8 1 2 6 976 2342 35 31 97.017525 of
5 1 8 1 2 7 1020 2342 134 31 95.804108 Arizona
5 1 8 1 2 8 1163 2339 68 33 96.579872 with
5 1 8 1 2 9 1242 2339 183 31 79.887253 certificates
5 1 8 1 2 10 1437 2337 35 32 96.994553 of
5 1 8 1 2 11 1480 2337 166 32 96.851448 insurance
5 1 8 1 2 12 1659 2334 90 41 93.303154 (valid
5 1 8 1 2 13 1760 2334 138 33 91.535843 ACORD
5 1 8 1 2 14 1910 2334 76 32 96.110245 form
5 1 8 1 2 15 1998 2340 35 24 96.328438 or
5 1 8 1 2 16 2042 2331 183 41 95.484863 equivalent
4 1 8 1 3 0 405 2378 1845 54 -1
5 1 8 1 3 1 405 2391 165 41 96.535927 approved
5 1 8 1 3 2 583 2391 38 39 96.902046 by
5 1 8 1 3 3 633 2390 51 33 97.002678 the
5 1 8 1 3 4 697 2390 86 31 96.949432 State
5 1 8 1 3 5 796 2388 31 32 96.908562 of
5 1 8 1 3 6 835 2387 142 40 96.831985 Arizona)
5 1 8 1 3 7 990 2385 186 39 96.819763 evidencing
5 1 8 1 3 8 1189 2385 64 30 96.990250 that
5 1 8 1 3 9 1263 2384 180 31 96.866600 Contractor
5 1 8 1 3 10 1453 2382 59 30 96.927681 has
5 1 8 1 3 11 1524 2379 56 33 96.635338 the
5 1 8 1 3 12 1590 2381 167 31 95.870514 insurance
5 1 8 1 3 13 1769 2387 38 22 92.871307 as
5 1 8 1 3 14 1820 2378 136 40 81.322586 réquired
5 1 8 1 3 15 1971 2378 39 40 96.977623 by
5 1 8 1 3 16 2022 2378 59 31 96.048828 this
5 1 8 1 3 17 2094 2378 156 30 95.936356 Contract.
4 1 8 1 4 0 403 2426 1170 48 -1
5 1 8 1 4 1 403 2439 46 32 96.604042 An
5 1 8 1 4 2 463 2435 182 33 95.839836 authorized
5 1 8 1 4 3 659 2433 238 41 96.620277 representative
5 1 8 1 4 4 909 2432 34 31 96.996094 of
5 1 8 1 4 5 952 2432 52 31 96.955070 the
5 1 8 1 4 6 1016 2432 123 31 94.157013 insurer
5 1 8 1 4 7 1149 2429 75 33 94.157013 shall
5 1 8 1 4 8 1237 2429 70 37 96.830925 sign
5 1 8 1 4 9 1318 2429 52 31 95.201241 the
5 1 8 1 4 10 1381 2426 192 33 95.201241 certificates.
3 1 8 2 0 0 301 2459 1997 147 -1
4 1 8 2 1 0 301 2459 1997 57 -1
5 1 8 2 1 1 301 2483 116 33 91.617538 20.7.1.
5 1 8 2 1 2 438 2481 44 32 90.485420 All
5 1 8 2 1 3 504 2481 84 32 96.843315 such
5 1 8 2 1 4 609 2478 180 33 43.752537 certificates
5 1 8 2 1 5 810 2477 33 33 96.313019 of
5 1 8 2 1 6 859 2477 166 31 95.578262 insurance
5 1 8 2 1 7 1046 2474 64 33 96.570496 and
5 1 8 2 1 8 1134 2474 96 39 96.570496 policy
5 1 8 2 1 9 1249 2472 242 32 96.536240 endorsements
5 1 8 2 1 10 1512 2471 86 31 96.936562 must
5 1 8 2 1 11 1617 2469 41 30 93.236885 be
5 1 8 2 1 12 1680 2468 140 31 87.710945 recelved
5 1 8 2 1 13 1844 2468 38 39 96.678680 by
5 1 8 2 1 14 1902 2466 50 33 96.466415 the
5 1 8 2 1 15 1976 2466 88 32 96.664833 State
5 1 8 2 1 16 2085 2466 111 32 96.664833 before
5 1 8 2 1 17 2216 2459 82 50 96.435799 work
4 1 8 2 2 0 439 2507 1859 52 -1
5 1 8 2 2 1 439 2531 221 27 88.558716 commences.
5 1 8 2 2 2 675 2523 66 32 96.801270 The
5 1 8 2 2 3 755 2522 114 33 44.040901 State's
5 1 8 2 2 4 883 2520 116 39 96.636635 receipt
5 1 8 2 2 5 1012 2519 34 31 97.019684 of
5 1 8 2 2 6 1057 2525 65 33 96.691277 any
5 1 8 2 2 7 1135 2517 182 33 94.737389 certificates
5 1 8 2 2 8 1330 2516 34 33 94.074471 of
5 1 8 2 2 9 1375 2514 167 35 94.074471 insurance
5 1 8 2 2 10 1555 2520 36 26 95.925133 or
5 1 8 2 2 11 1604 2511 99 41 95.925133 policy
5 1 8 2 2 12 1716 2511 242 33 91.564636 endorsements
5 1 8 2 2 13 1971 2510 64 33 96.746475 that
5 1 8 2 2 14 2048 2510 43 33 96.525986 do
5 1 8 2 2 15 2108 2510 55 33 96.591003 not
5 1 8 2 2 16 2175 2507 123 40 80.359108 comply
4 1 8 2 3 0 438 2555 1670 51 -1
5 1 8 2 3 1 438 2568 71 35 96.913605 with
5 1 8 2 3 2 524 2568 61 35 96.746819 this
5 1 8 2 3 3 594 2567 112 33 89.927338 written
5 1 8 2 3 4 719 2565 181 41 96.832664 agreement
5 1 8 2 3 5 910 2565 77 32 96.485901 shall
5 1 8 2 3 6 1000 2564 56 31 93.030014 not
5 1 8 2 3 7 1065 2562 101 32 88.967682 walve
5 1 8 2 3 8 1177 2570 35 24 96.883263 or
5 1 8 2 3 9 1221 2559 163 33 96.958427 otherwise
5 1 8 2 3 10 1395 2559 96 32 96.624435 affect
5 1 8 2 3 11 1500 2559 51 32 96.982086 the
5 1 8 2 3 12 1564 2556 226 41 96.574730 requirements
5 1 8 2 3 13 1800 2556 35 30 95.056786 of
5 1 8 2 3 14 1844 2555 58 34 96.919571 this
5 1 8 2 3 15 1913 2556 195 38 93.933006 agreement.
3 1 8 3 0 0 303 2597 1997 139 -1
4 1 8 3 1 0 303 2597 1997 54 -1
5 1 8 3 1 1 303 2616 114 33 80.996368 20,7.2.
5 1 8 3 1 2 441 2613 92 33 97.000793 Each
5 1 8 3 1 3 552 2613 164 32 84.344910 Insurance
5 1 8 3 1 4 733 2610 96 41 95.519768 policy
5 1 8 3 1 5 846 2609 135 40 96.774841 required
5 1 8 3 1 6 1002 2607 39 41 96.906563 by
5 1 8 3 1 7 1059 2607 61 32 96.815918 this
5 1 8 3 1 8 1138 2606 145 31 96.395409 Contract
5 1 8 3 1 9 1299 2606 84 30 95.766357 must
5 1 8 3 1 10 1399 2604 40 32 95.766357 be
5 1 8 3 1 11 1456 2604 29 30 96.918159 in
5 1 8 3 1 12 1503 2603 95 31 96.183289 effect
5 1 8 3 1 13 1614 2603 41 36 95.706642 at,
5 1 8 3 1 14 1674 2609 33 24 96.812256 or
5 1 8 3 1 15 1724 2601 78 39 96.883911 prior
5 1 8 3 1 16 1817 2601 39 36 96.348305 to,
5 1 8 3 1 17 1875 2600 281 31 96.551765 commencement
5 1 8 3 1 18 2171 2598 34 30 96.293213 of
5 1 8 3 1 19 2217 2597 83 31 96.884865 work
4 1 8 3 2 0 441 2642 1857 48 -1
5 1 8 3 2 1 441 2658 105 32 96.626831 under
5 1 8 3 2 2 562 2657 58 31 96.562828 this
5 1 8 3 2 3 637 2657 152 31 88.250038 Contract.
5 1 8 3 2 4 808 2655 116 32 87.141418 Failure
5 1 8 3 2 5 940 2654 32 30 96.927055 to
5 1 8 3 2 6 988 2652 148 32 96.915291 maintain
5 1 8 3 2 7 1155 2652 51 32 96.653595 the
5 1 8 3 2 8 1224 2651 164 31 96.560905 insurance
5 1 8 3 2 9 1405 2648 127 40 74.506020 policies
5 1 8 3 2 10 1549 2655 41 23 96.936127 as
5 1 8 3 2 11 1608 2646 140 41 96.723801 required
5 1 8 3 2 12 1766 2646 40 38 95.990181 by
5 1 8 3 2 13 1821 2643 59 32 95.990181 this
5 1 8 3 2 14 1898 2645 151 36 94.007423 Contract,
5 1 8 3 2 15 2072 2651 34 24 96.998238 or
5 1 8 3 2 16 2124 2643 30 32 95.737556 to
5 1 8 3 2 17 2174 2642 124 39 96.935684 provide
4 1 8 3 3 0 441 2694 902 42 -1
5 1 8 3 3 1 441 2703 159 32 96.350800 evidence
5 1 8 3 3 2 610 2702 35 30 96.470055 of
5 1 8 3 3 3 655 2700 140 36 96.843155 renewal,
5 1 8 3 3 4 808 2700 26 30 64.528610 Is
5 1 8 3 3 5 846 2708 20 21 64.528610 a
5 1 8 3 3 6 876 2697 137 32 58.646919 material
5 1 8 3 3 7 1024 2697 121 32 96.306068 breach
5 1 8 3 3 8 1156 2696 35 30 96.907425 of
5 1 8 3 3 9 1200 2694 143 32 91.028725 contract.
3 1 8 4 0 0 303 2732 2000 189 -1
4 1 8 4 1 0 303 2732 1995 52 -1
5 1 8 4 1 1 303 2750 115 31 66.702621 20.7.3.
5 1 8 4 1 2 439 2747 44 33 92.459129 All
5 1 8 4 1 3 507 2745 184 33 96.316452 certificates
5 1 8 4 1 4 712 2742 136 42 95.803024 required
5 1 8 4 1 5 868 2742 40 41 96.967873 by
5 1 8 4 1 6 927 2741 59 33 96.435669 thls
5 1 8 4 1 7 1006 2739 151 33 96.587646 Contract
5 1 8 4 1 8 1176 2738 77 33 94.198563 shall
5 1 8 4 1 9 1272 2738 41 30 96.634941 be
5 1 8 4 1 10 1333 2738 76 31 96.895775 sent
5 1 8 4 1 11 1425 2736 120 39 96.637115 directly
5 1 8 4 1 12 1566 2736 30 32 91.412476 to
5 1 8 4 1 13 1616 2736 55 30 96.733925 the
5 1 8 4 1 14 1692 2733 204 39 85.447334 Department.
5 1 8 4 1 15 1919 2733 65 32 96.687607 The
5 1 8 4 1 16 2006 2733 88 30 96.954124 State
5 1 8 4 1 17 2118 2732 32 30 96.123596 of
5 1 8 4 1 18 2169 2732 129 31 95.511642 Arizona
4 1 8 4 2 0 441 2772 1862 59 -1
5 1 8 4 2 1 441 2789 269 42 84.091599 project/contract
5 1 8 4 2 2 725 2789 129 31 94.765961 number
5 1 8 4 2 3 865 2787 64 32 96.368309 and
5 1 8 4 2 4 945 2784 119 41 96.368309 project
5 1 8 4 2 5 1077 2783 185 39 73.935410 description
5 1 8 4 2 6 1277 2781 76 32 95.448502 shall
5 1 8 4 2 7 1370 2781 41 30 96.795471 be
5 1 8 4 2 8 1428 2780 92 31 95.164909 noted
5 1 8 4 2 9 1536 2787 42 24 95.164909 on
5 1 8 4 2 10 1593 2780 54 30 95.710121 the
5 1 8 4 2 11 1662 2777 164 31 74.522957 certificate
5 1 8 4 2 12 1841 2778 34 30 96.641235 of
5 1 8 4 2 13 1889 2777 174 31 86.633301 insurance,
5 1 8 4 2 14 2079 2775 69 33 96.684174 The
5 1 8 4 2 15 2166 2775 87 32 96.916969 State
5 1 8 4 2 16 2268 2772 35 33 96.898018 of
4 1 8 4 3 0 441 2819 1860 51 -1
5 1 8 4 3 1 441 2835 137 33 90.289482 Arizona
5 1 8 4 3 2 594 2841 146 26 96.930595 reserves
5 1 8 4 3 3 754 2832 53 32 96.765503 the
5 1 8 4 3 4 822 2831 74 39 95.731781 right
5 1 8 4 3 5 910 2832 31 30 95.731781 to
5 1 8 4 3 6 957 2829 123 41 96.770760 require
5 1 8 4 3 7 1095 2828 155 39 95.451576 complete
5 1 8 4 3 8 1266 2826 108 41 91.685837 copies
5 1 8 4 3 9 1390 2825 35 33 96.776840 of
5 1 8 4 3 10 1437 2825 39 33 96.833031 all
5 1 8 4 3 11 1491 2825 168 33 96.612083 insurance
5 1 8 4 3 12 1675 2822 128 40 82.574898 policies
5 1 8 4 3 13 1818 2820 137 41 96.531097 required
5 1 8 4 3 14 1973 2820 40 41 96.341537 by
5 1 8 4 3 15 2028 2820 61 32 96.341537 this
5 1 8 4 3 16 2106 2819 149 33 40.020237 Contract
5 1 8 4 3 17 2267 2819 34 30 96.812561 at
4 1 8 4 4 0 442 2871 1082 50 -1
5 1 8 4 4 1 442 2886 62 35 96.475822 any
5 1 8 4 4 2 520 2879 82 33 93.886887 time.
2 1 9 0 0 0 270 2970 2030 71 -1
3 1 9 1 0 0 270 2970 2030 71 -1
4 1 9 1 1 0 270 2970 1811 33 -1
5 1 9 1 1 1 270 2973 83 30 91.653732 20.8.
5 1 9 1 1 2 411 2970 311 29 88.648773 SUBCONTRACTORS
4 1 9 1 2 0 2103 3006 197 35 -1
5 1 9 1 2 1 2103 3009 81 32 96.070496 Page
5 1 9 1 2 2 2198 3009 16 24 95.496681 9
5 1 9 1 2 3 2225 3006 31 29 95.603058 of
5 1 9 1 2 4 2264 3008 36 25 96.480034 20
2 1 10 0 0 0 2439 180 42 3035 -1
3 1 10 1 0 0 2439 180 42 3035 -1
4 1 10 1 1 0 2439 180 42 3035 -1
5 1 10 1 1 1 2439 180 42 3035 95.000000
Contractor's certificate(s) shall include all subcontractors as insureds under its policies or Contractor shail be
responsible for ensuring and/or verifying that all subcontractors have valid and collectable insurance as
evidenced by the cerlificates of insurance and endorsements for each subcontractor. All coverages for
subcontractors shalt be subject to the minimum Insurance Requirements Identified above. The Department
reserves the right fo require, at any time throughout the life of the Contract, proof from the Contractor that its
subcontractors have the required coverage.
20.9. APPROVAL AND MODIFICATIONS
The Contracting Agency, in consultation with State Risk, reserves the right to review or make modifications to
the insurance limits, required coverages, or endorsements throughout the life of this contract, as deemed
necessary. Such action will not require a formal Contract amendment, but may be made by administrative
‘
action.
20,10. EXCEPTIONS
In the event the Contractor or subcontractor(s) is/are a public entity, then the Insurance Requirements shall
not apply. Such public entity shall provide a certificate of self-insurance. If the Contractor or subcontractor(s)
isfare a State of Arizona agency, board, commission, or university, none of the above shail apply.
IT 508 COMPLIANCE
Unless specifically authorized in the Agreement, any electronic or information technology offered to the State
of Arizona under this agreement shall comply with A.R.S. §§ 18-131 and 132 and Section 508 of the
Rehabilitation Act of 1973, which requires that employees and members of the public shall have access to and
use of Information technology that is comparable to the access and use by employees and members of the
public who are not individuals with disabilities.
“
22.8 NON-AVAILABILITY OF FUNDS
22.1, In accordance with A.R.S. § 35-154, every payment obligation of the State under the Agreement is conditioned
upon the availability of funds appropriated or allocated for payment of such obligation. If funds are not
allocated and available for the continuance of this Agreement, this Agreement may be terminated by the State
at the end of the period for which funds are avallable. No liability shall accrue to the State in the event this
provision is exercised, and the State shall not be obligated or liable for any future payments or for any
damages as a result of termination under this paragraph.
23.0 NON-DISCRIMINATION
23.1. Each Party shall comply with State Executive Order No. 2009-09 and all other applicable Federal and State
laws, rules and regulations, including the Americans with Disabilities Act,
23.2, Not apply to indirect or ‘overhead’ services, redundant back-up services or services that are incidental to the
performance of the Agreement. This provision applies to work performed by subcontractor at all tiers,
24.0 THIRD- PARTY ANTITRUST VIOLATIONS
A. The Clerk assigns to ADES any claim for overcharges resulting from antifrust violations concerning
materials or services supplied by third parties to the Clerk, toward fulfillment of this Agreement.
25.0 ATTACHMENTS
25.1. The following list of attachments constitutes an Integral part of subject agreement:
26.2. Attachment 1- Certification Regarding Maintenance of Effort
25.3, Atlachment 2 - Certification Regarding Lobbying
’
26.0 EXHIBITS
26.1. The following list of exhibits constitutes an integral part of subject agreement:
Exhibit A - Certified Public Expenditure Statement (CPES) CS-016-FF and IV-D Compensation Form
26.3. Exhibit B - Sub Recipient Incentive Report
26.4. Exhibit C - Sub Recipient Fact Sheet
27.0 CONFIDENTIALITY
27.4. Each Party shall observe and abide by all applicable State and federal statutes, rules and regulations
regarding the use or disclosure of information including, but not limited to, information concerning applicants
Page 10 of 20
+
for and recipients of contract services. To the extent permitted by law, the Clerk shall release information to
ADES and to the Attorney General's Office as required by the terms of this Agreement, by law or upon their
request.
27.2, The Clerk shall comply with the requirements of Arizona Address Confidentiallty Program, A.R.S, § 41-161 et,
seq. ADES will advise the Clerk as to applicable policies and procedures ADES has adopted for such
compliance.
28.0 DATA SHARING AGREEMENT
28.1. When determined by ADES that sharing of confidential data will occur with the Clerk, the Clerk shall complete
ADES Data Sharing Request Agreement and submit the completed Agreement to ADES Program Designated
Staff prior to any work commencing or data shared. A separate Data Sharing Request Agreement shail be
required between the Clerk and each ADES Program sharing confidential data.
29.0 SAFEGUARDING OF TAX INFORMATION PER IRS PUBLICATION 4075
29.1, The judicial officer and ADES agree to comply with all federal statutory and regulatory provisions requiting that
‘information be safeguarded and kept confidential. These statutes and regulations Include, but are not fimited
to, 45 CFR § 309.80; 45 CFR §303.21 (Safeguarding Information); 45 CFR § 303.30 {Securing Medical
Support Information); and the United States Internal Revenue Code (IRC) 6103.
30.8 PERFORMANGE
In performance of this contract, the Clerk and ADES agree to comply with and assume responsibility for
compliance by his or her employees with the following requirements:
All work will be done under the supervision of the judicial officer, the Clerk officer's employees or the ADES-or
the ADES employees:
Any return or return Information made available in any format shail be used only for the purpose of carrying out
the provisions of this contract. Information contained in such material will be treated as confidential and will not
be divulged or made known in any manner to any person except as may be necessary In the performance of
this contract. Disclosure to anyone other than an officer or employee of the Clerk and ADES will be prohibited.
All returns and return information will be accounted for upon receipt and properly stored before, during, and
after processing. In addition, all related output will be given the same level of protection as required for the
source material.
The Clerk and ADES certify that the data processed during the performance of this contract will be completely
purged from all data storage components of his or her computer facility, and no output will be retained by the
Clerk and ADES at the time the work Is completed. If Immediate purging of all data storage components Is not
possible, the Judicial officer and ADES certify that any IRS data remaining in any storage component will be
.
safeguarded to prevent unauthorized disclosures.
Any spollage or any intermediate hard copy printout that may result during the processing of IRS dala will be
given to the agency or his or her designee, When this is not possible, the judicial officer and ADES will be
responsible for the destruction of the spoilage or any intermediate hard copy printouts, and will provide the
agency or his or her designee with a statement containing the date of destruction, description of material
destroyed, and the method used.
All computer systems processing, storing, or transmitting Federal tax information must meet the requirements
defined in IRS Publication 1075. To meet functional and assurance requirements, the security features of the
environment must provide for the managerial, operational, and technical controls. All security features must be
available and activated to pratect against unauthorized use of and access to Federal tax information.
No work Involving Federal tax Information furnished under this contract will be subcontracted without prior
willten approval of the IRS.
The Clerk and ADES will maintain a list of employees authorized access. Such list will be provided to the
agency and, upon request, to the IRS reviewing office.
34.0 CRIMINAL/CIVIL SANCTIONS:
Each officer or employee of any person to whom returns or return information Is or may be disclosed will be
notified In writing by such person that returns or return information disclosed to such officer or employee can
be used only for a purpose and ta the extent authorized herein, and that further disclosure of any such returns
or return information for a purpose or to an extent unauthorized herein constitutes a felony punishable upon
conviction by a fine of as much as $5,000 or imprisonment for as long as 5 years, or both, together with the
costs of prosecution. Such person shall also notify each such officer and employee that any such unauthorized
further disclosure of returns or return information may also result in an award of civil damages against the
Page 11 of 20
officer or employee in an amount not less than $71,000 with respect to each instance of unauthorized
disclosure. These penalties are prescribed by IRC sections 7213 and 7431 and set forh at 26 CFR
301.6103(n)-1. ;
Each officer or employee of any person to whom returns or return information Is or may be disclosed shail be
notified in writing by such person that any return or return Information made available in any format shall be
used only for the purpose of carrying out the provisions of this contract. Information contained in such material
shail be treated as confidential and shall nat be divulged or made known jn any manner to any person except
as may be necessary in the performance of the contract. Inspection by or disclosure to anyone without an
official need to know constitutes a criminal misdemeanor punishable upon conviction by a fine of as much as
$1,000 or imprisonment for as {ong as 1 year, or both, together with the costs of prosecution, Such person
shall also notify each such officer and employee that any such unauthorized inspection or disclosure of returns
or return information may also result in an award of civil damages against the officer or employee [United
States for Federal employees] in an amount equal to the sum of the greater of $1,000 for each act of
unauthorized Inspection or disclosure with respect to which such defendant is found liable or the sum of the
actual damages sustained by the plaintiff as a result of such unauthorized inspection or disclosure plus in the
case of a willful Inspection or disclosure which Is the result of gross negligence, punitive damages, plus the
costs of the action. These penalttes are prescribed by IRGC section 7213A and 7431.
Additionally, it is incumbent upon the Judicial officer and ADES to inform its officers and employees of the
penalties for Improper disclosure imposed by the Privacy Act of 1974, 6 U.S.C. 552a, Specifically, 5 U.S.C.
552a(i)(1), which is made applicable to the Courts by 5 U.S.C. 652a (m)(1), provides that any officer or
employee of a the Court, who by virtue of his/her employment or official position, has possession of or access
to agency records which contain individually tdentiflable Information, the disclosure of which |s prohibited by
the Privacy Act or regulations established thereunder, and who knowing that disclosure of the specifle material
is prohibited, wilifully discloses the material in any manner to any person or agency not entitled to receive it,
shall be guilty of a misdemeanor and fined not more than $5,000. The agency will have the right to vold the
contract if either party fails to provide the safeguards described above,
,
32.0 INSPECTION
The IRS and the ADES shall have the right fo send Its officers and employees Into the offices and plants of
either party for inspection of the facilities and operations provided for the performance of any work under this
contract. On the basis of such inspection, specific measures may be required in cases where elther party fs
found to be noncompliant with contract safeguards.
33.0 SIGNATURES IN COUNTERPART
This agreement may be executed in any number of counterparts, each of which when executed and delivered
shall constitute a duplicate original, but all counterparts together shall constitute a single agreement.
33.0 OFFSHORE PERFORMANCE OF WORK PROHIBITED
Due to security and identify protection concerns, direct services under this Agreement shall be performed
within the borders of the United States. Any services that are described in the specifications or scope of work that
directly serve the State of Arizona or Its clients and may Involve access to secure or sensitive data or personal
client data or development or modification of software for the State shail be performed within the borders of the
United States. Unless specifically stated otherwise in the specification, this definition does not apply to indirect
or “overtiead® services, redundant back-up services or services that are incidental to the performance of the
Agreement. This provision applies fo work performed by subcontractors at ail tlers.
Page 12 of 20
ATTAGHMENT 1
CERTIFICATION REGARDING MAINTENANCE OF EFFORT
In accordance with the applicable program statute(s) and regulation(s), the undersigned certifies
that financial assistance provided by the Administration for Children and Families, for the specified
activities to be performed under the Grants for Judicial Services by
Will be in addition to, and notin
_
“TApprcant Organization)
substitution for, comparable activities previously carried on without Federal assistance.
Signature of Authorized Certifying Official
Title
Date
Page 13 of 20
ATTACHMENT 2
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been pald or will be pald, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, continuation, renewal, amendment, or madification of any Federal
contract, grant, loan, or cooperative agreernent.
(2) if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting fo influence an officer or employee of any agency, a Member of Congress, an officer of employee of
Congress, or an employee of a Member of Congress In connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure
5 1 7 1 4 12 1988 1266 88 32 95.506233 Form
5 1 7 1 4 13 2087 1267 31 29 96.423058 to
5 1 7 1 4 14 2130 1265 114 40 96.907463 Report
4 1 7 1 5 0 265 1306 775 38 -1
5 1 7 1 5 1 265 1306 178 38 95.326111 Lobbying,”
5 1 7 1 5 2 457 1308 28 32 95.153015 in
5 1 7 1 5 3 499 1306 199 32 96.779716 accordance
5 1 7 1 5 4 708 1306 69 32 96.673744 with
5 1 7 1 5 5 789 1307 36 31 94.651222 its
5 1 7 1 5 6 837 1306 203 32 93.877045 instructions.
2 1 8 0 0 0 262 1377 2009 147 -1
3 1 8 1 0 0 262 1377 2009 147 -1
4 1 8 1 1 0 264 1377 2007 59 -1
5 1 8 1 1 1 264 1393 47 43 91.792885 (3)
5 1 8 1 1 2 403 1394 67 31 96.931061 The
5 1 8 1 1 3 483 1395 210 38 95.463821 undersigned
5 1 8 1 1 4 706 1395 79 32 95.412064 shall
5 1 8 1 1 5 796 1395 121 38 95.694107 require
5 1 8 1 1 6 928 1395 64 32 95.694107 that
5 1 8 1 1 7 1003 1395 53 32 96.862984 the
5 1 8 1 1 8 1068 1395 155 41 96.863106 language
5 1 8 1 1 9 1233 1396 33 31 96.950294 of
5 1 8 1 1 10 1276 1395 59 32 94.659744 this
5 1 8 1 1 11 1347 1395 191 33 95.140594 certification
5 1 8 1 1 12 1552 1377 41 51 96.958923 be
5 1 8 1 1 13 1606 1396 146 32 96.729378 included
5 1 8 1 1 14 1765 1395 26 32 87.224792 In
5 1 8 1 1 15 1804 1396 52 32 96.805412 the
5 1 8 1 1 16 1867 1398 106 30 96.672958 award
5 1 8 1 1 17 1985 1398 181 32 94.047173 documents
5 1 8 1 1 18 2180 1399 45 31 96.951271 for
5 1 8 1 1 19 2235 1398 36 33 74.952240 all
4 1 8 1 2 0 262 1438 1864 43 -1
5 1 8 1 2 1 262 1438 200 32 91.520981 sub-awards
5 1 8 1 2 2 475 1440 35 30 95.315453 at
5 1 8 1 2 3 520 1440 38 30 93.305687 all
5 1 8 1 2 4 570 1439 72 31 92.101662 tlers
5 1 8 1 2 5 655 1440 161 39 91.323425 (including
5 1 8 1 2 6 828 1439 227 37 93.284348 subcontracts,
5 1 8 1 2 7 1068 1438 174 40 92.837250 subgrants,
5 1 8 1 2 8 1257 1440 62 30 97.017136 and
5 1 8 1 2 9 1332 1440 155 32 96.444717 contracts
5 1 8 1 2 10 1498 1440 100 32 96.444717 under
5 1 8 1 2 11 1608 1442 119 37 96.527382 grants,
5 1 8 1 2 12 1740 1440 99 38 85.703888 loans,
5 1 8 1 2 13 1854 1440 62 32 96.001129 and
5 1 8 1 2 14 1928 1443 198 38 96.149925 cooperative
4 1 8 1 3 0 262 1482 1297 42 -1
5 1 8 1 3 1 262 1483 218 40 87.828407 agreements)
5 1 8 1 3 2 493 1482 65 32 95.928154 and
5 1 8 1 3 3 568 1482 67 32 96.222839 that
5 1 8 1 3 4 645 1482 38 33 93.231316 all
5 1 8 1 3 5 693 1483 228 40 10.731592 subrecipients
5 1 8 1 3 6 933 1483 77 32 85.072693 shall
5 1 8 1 3 7 1021 1483 103 40 96.342674 certify
5 1 8 1 3 8 1135 1483 61 32 96.493057 and
5 1 8 1 3 9 1208 1482 138 33 96.493057 disclose
5 1 8 1 3 10 1357 1484 202 40 95.758873 accordingly.
2 1 9 0 0 0 262 1571 2020 174 -1
3 1 9 1 0 0 262 1571 2020 174 -1
4 1 9 1 1 0 262 1571 1985 42 -1
5 1 9 1 1 1 262 1572 74 32 96.973457 This
5 1 9 1 1 2 348 1571 197 33 96.357735 certification
5 1 9 1 1 3 558 1572 26 32 96.628120 is
5 1 9 1 1 4 594 1581 21 21 96.648224 a
5 1 9 1 1 5 627 1571 136 31 63.521271 material
5 1 9 1 1 6 775 1573 244 38 88.671532 representation
5 1 9 1 1 7 1032 1572 35 32 96.729301 of
5 1 9 1 1 8 1074 1572 63 32 96.980072 fact
5 1 9 1 1 9 1147 1579 83 32 96.325455 upon
5 1 9 1 1 10 1240 1572 100 32 93.123322 which
5 1 9 1 1 11 1351 1572 134 33 92.598343 rellance
5 1 9 1 1 12 1494 1579 69 26 96.617622 was
5 1 9 1 1 13 1577 1573 114 40 96.716141 placed
5 1 9 1 1 14 1701 1574 93 33 93.822449 when
5 1 9 1 1 15 1805 1575 58 32 93.287781 this
5 1 9 1 1 16 1876 1574 187 33 91.595741 fransaction
5 1 9 1 1 17 2073 1582 65 25 96.666214 was
5 1 9 1 1 18 2151 1578 96 29 96.630295 made
4 1 9 1 2 0 262 1614 2020 45 -1
5 1 9 1 2 1 262 1624 37 25 96.746536 or
5 1 9 1 2 2 309 1616 128 33 96.746536 entered
5 1 9 1 2 3 450 1616 74 33 71.610954 into.
5 1 9 1 2 4 549 1614 195 35 91.105614 Submisston
5 1 9 1 2 5 757 1615 34 32 96.886162 of
5 1 9 1 2 6 799 1615 59 32 94.241463 this
5 1 9 1 2 7 869 1616 196 33 96.234222 certification
5 1 9 1 2 8 1078 1617 26 32 96.176552 is
5 1 9 1 2 9 1116 1624 18 25 96.861214 a
5 1 9 1 2 10 1148 1616 196 42 96.751442 prerequisite
5 1 9 1 2 11 1357 1617 44 32 96.737251 for
5 1 9 1 2 12 1411 1617 122 39 96.737251 making
5 1 9 1 2 13 1546 1624 37 26 96.946297 or
5 1 9 1 2 14 1591 1618 142 38 96.619705 entering
5 1 9 1 2 15 1746 1618 62 32 90.824348 Into
5 1 9 1 2 16 1818 1618 59 32 96.963699 this
5 1 9 1 2 17 1889 1619 186 33 96.460495 transaction
5 1 9 1 2 18 2087 1620 142 39 96.731155 imposed
5 1 9 1 2 19 2241 1620 41 39 97.007744 by
4 1 9 1 3 0 262 1660 1889 41 -1
5 1 9 1 3 1 262 1660 121 32 96.465752 section
5 1 9 1 3 2 397 1661 95 37 96.357590 1352,
5 1 9 1 3 3 506 1660 60 32 96.102310 title
5 1 9 1 3 4 579 1660 49 37 89.691475 34,
5 1 9 1 3 5 642 1660 70 32 90.464523 U.S.
5 1 9 1 3 6 727 1660 98 32 83.069420 Code,
5 1 9 1 3 7 849 1660 68 40 96.462204 Any
5 1 9 1 3 8 931 1668 113 32 96.164314 person
5 1 9 1 3 9 1056 1660 71 32 95.623985 who
5 1 9 1 3 10 1137 1660 68 32 51.366772 falls
5 1 9 1 3 11 1216 1660 29 34 95.165489 to
5 1 9 1 3 12 1257 1661 50 33 95.165489 file
5 1 9 1 3 13 1317 1660 53 32 94.928337 the
5 1 9 1 3 14 1380 1660 141 41 96.931694 required
5 1 9 1 3 15 1531 1660 200 34 96.717560 certification
5 1 9 1 3 16 1743 1663 78 29 96.115280 shall
5 1 9 1 3 17 1833 1663 41 29 97.003502 be
5 1 9 1 3 18 1887 1662 123 39 96.552391 subject
5 1 9 1 3 19 2021 1665 27 30 94.611618 to
5 1 9 1 3 20 2061 1671 21 24 94.951714 a
5 1 9 1 3 21 2093 1663 58 32 94.951714 civil
4 1 9 1 4 0 262 1704 1411 41 -1
5 1 9 1 4 1 262 1705 125 40 94.606903 penalty
5 1 9 1 4 2 399 1704 33 33 96.841858 of
5 1 9 1 4 3 442 1705 55 32 94.890823 nat
5 1 9 1 4 4 510 1705 68 31 91.884781 fess
5 1 9 1 4 5 588 1705 72 32 96.153252 than
5 1 9 1 4 6 673 1704 139 38 96.412178 $10,000
5 1 9 1 4 7 822 1705 65 31 96.754028 and
5 1 9 1 4 8 900 1706 54 30 95.878403 not
5 1 9 1 4 9 964 1713 86 23 95.878403 more
5 1 9 1 4 10 1062 1704 72 32 96.970520 than
5 1 9 1 4 11 1147 1704 158 39 89.185921 $100,000
5 1 9 1 4 12 1315 1706 47 31 96.859413 for
5 1 9 1 4 13 1371 1705 83 32 96.764503 each
5 1 9 1 4 14 1465 1705 79 32 96.986450 such
5 1 9 1 4 15 1556 1705 117 32 96.351128 failure.
2 1 10 0 0 0 259 1908 1637 18 -1
3 1 10 1 0 0 259 1908 1637 18 -1
4 1 10 1 1 0 259 1908 1637 18 -1
5 1 10 1 1 1 259 1908 1637 18 95.000000
2 1 11 0 0 0 262 1925 1496 33 -1
3 1 11 1 0 0 262 1925 1496 33 -1
4 1 11 1 1 0 262 1925 1496 33 -1
5 1 11 1 1 1 262 1926 227 32 95.649025 SIGNATURE
5 1 11 1 1 2 501 1926 54 32 95.649025 OF
5 1 11 1 1 3 565 1925 248 33 95.950600 AUTHORIZED
5 1 11 1 1 4 825 1926 234 32 95.311478 CERTIFYING
5 1 11 1 1 5 1071 1926 170 32 95.651939 OFFICIAL
5 1 11 1 1 6 1651 1928 107 30 95.712196 TITLE
2 1 12 0 0 0 259 2219 1636 16 -1
3 1 12 1 0 0 259 2219 1636 16 -1
4 1 12 1 1 0 259 2219 1636 16 -1
5 1 12 1 1 1 259 2219 1636 16 95.000000
2 1 13 0 0 0 259 2235 1588 35 -1
3 1 13 1 0 0 259 2235 1588 35 -1
4 1 13 1 1 0 259 2235 1588 35 -1
5 1 13 1 1 1 259 2235 218 33 96.543739 APPLICANT
5 1 13 1 1 2 489 2235 291 33 96.326912 ORGANIZATION
5 1 13 1 1 3 1512 2237 101 33 96.337898 DATE
5 1 13 1 1 4 1624 2237 223 33 96.370651 SUBMITTED
2 1 14 0 0 0 2070 2999 210 34 -1
3 1 14 1 0 0 2070 2999 210 34 -1
4 1 14 1 1 0 2070 2999 210 34 -1
5 1 14 1 1 1 2070 2999 76 34 96.690216 Page
5 1 14 1 1 2 2157 3000 39 27 95.701569 14
5 1 14 1 1 3 2205 3000 32 27 96.923927 of
5 1 14 1 1 4 2243 3000 37 27 96.834427 20
2 1 15 0 0 0 2542 162 8 873 -1
3 1 15 1 0 0 2542 162 8 873 -1
4 1 15 1 1 0 2542 162 8 873 -1
5 1 15 1 1 1 2542 162 8 873 95.000000
EXHIBIT A
CERTIFIED PUBLIG EXPENDITURE STATEMENT OF (CPES) GS-918-FF
AND
1V-D COMPENSATION FORM
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
CS-O16-FF (2-09)
COUNTY
Child Support Enforcement Contract Administration
PO Box 40458 ?Phosntx, Arizona 85067
REPORTED MONTH
;
CERTIFIED PUBLIC EXPENDITURES STATEMENT
AGIUAL EXPENDITURE FOR
{K] Clerk of Suparior Court (1 Sheriff Family Law Commissioner
County Attorney
PERSON'S HANE PREPARING FHIS REPORT DATE PHONE HO, EXPENDITURE
- :
{. PersonalServices ( Number of FTE}
2. Employee-Relaled Expenses {ERE) ( FICA, Unemployment fasurance, Worker's Compensation,
Retirement, Health, Life & Accident Insurance)
$ -
3, Professional and Outside Services (Specify)
4, Travel Number of
B, Perdiamand Other |S - $ -
A, Mileage Rate Mites
5. Space (Sunt of 6A, 4B, and 5C}
B.Ulites $ $ + C. Use Allowance $ $ -
A. Rent
6. { Sum of 6A, 6B, and 80) A, Malntenance/Repalr, Non-ADP $ $ -
Equiprnent
G. From CS-016-B, lined § $ -
B, From CS-016-A, Lina & $
7, Meterlals and Supplies ( Sum of 7A, 7B, 7, and 7D)
$ - 6.Printng $0.00 D. Photocopying $ $ .
A. Suppltes $ .~ 8B. Postage
8, Operaling Expsnses { Sunt of 8A, 6B, aC, &b, amd 6&)
D, Membaiship Duas $
A, Telephone $
B. Insurance/Bonding $ Name:
£, Subscriptians $
G, Other (Pagel}
Softwara Misc Leases RIM Grounds
Offiee Suppiles Tools
$ - § $ - $ $ - Name S$ - $ + $ -
$$
indirect Costs ( Enler the hudgeled tate end the dollar ‘amount of the base to Whloh this rate is appiled}
9.
$ -
Rate % Base: $ -
$ -
40. Total Expenditures
$ -
*44 Lass Disallowance Per
ALLOWABLE EXPENDITURES( °37 AND 12 to be complated only by DCSE. If completed, fine
742.
42 ts basis tor Une 14 below and for tine 1 of the CS-105-D)
13. TOTAL GREDITS (Sum of all fees collected)
Other { Specify}
4. $ -
Handllng Fees $
12 $ -
3, $ - $ -
Lab Fars 3
$ ~
14. NET EXPENDITURES (Alfowable Expenditures minus Tofa} Credits}
66.00%
76. Reimbursement Rale, According to Contract { Mullfply)
$ -
46, TOTAL REIMBURSEMENT AMOUNT DUE
} under penaillles of podury, that this Gertiled Public Expendilures Statement 45 CFR 304.30 {a}(2)()
GERVIFIGATION: cestify,
and, to the bast of nly knowledge and bellef, itls 2 true, cotfect and valid daim against the Slate of
\has been examinad by me
Asizona, and paymont haa not bean fecelved,
YTLE DATE
[AUTHORIZED SIGNATURE
ISSUE WARRANY PAYABLE TO
MAILING ADDRESS (No., Streat or PO Box Na., Clly, Slate, ZiP}
Page 45 of 20
EXHIBIT A
I¥-D COMPENSATION FORM
Name of Your Agency
Clerk of Court
Enter Month and Year
TOTALCOMPENSATION VD COMPENSATION
a a on | Total
4 1 4 1 7 0 335 691 1884 61 -1
5 1 4 1 7 1 335 697 49 28 30.554195 Jab
5 1 4 1 7 2 391 692 98 61 29.788465 Tile}
5 1 4 1 7 3 514 698 77 25 83.810196 Name
5 1 4 1 7 4 678 718 59 25 96.973595 Rate
5 1 4 1 7 5 807 712 80 40 52.606705 Hours
5 1 4 1 7 6 967 710 80 41 90.489937 Salary
5 1 4 1 7 7 1158 694 48 26 92.484436 ERE
5 1 4 1 7 8 1291 714 194 31 35.732208 tampensstion{
5 1 4 1 7 9 1527 712 77 28 93.206268 Hours
5 1 4 1 7 10 1683 708 87 40 40.125446 Salary
5 1 4 1 7 11 1878 691 48 26 89.871513 ERE
5 1 4 1 7 12 2018 707 201 40 54.346523 campensation
2 1 5 0 0 0 319 737 1925 22 -1
3 1 5 1 0 0 319 737 1925 22 -1
4 1 5 1 1 0 319 737 1925 22 -1
5 1 5 1 1 1 319 737 1925 22 95.000000
2 1 6 0 0 0 319 976 148 5 -1
3 1 6 1 0 0 319 976 148 5 -1
4 1 6 1 1 0 319 976 148 5 -1
5 1 6 1 1 1 319 976 148 5 95.000000
2 1 7 0 0 0 319 1336 148 4 -1
3 1 7 1 0 0 319 1336 148 4 -1
4 1 7 1 1 0 319 1336 148 4 -1
5 1 7 1 1 1 319 1336 148 4 95.000000
2 1 8 0 0 0 316 660 11 1130 -1
3 1 8 1 0 0 316 660 11 1130 -1
4 1 8 1 1 0 316 660 11 1130 -1
5 1 8 1 1 1 316 660 11 1130 95.000000
2 1 9 0 0 0 2238 604 10 1177 -1
3 1 9 1 0 0 2238 604 10 1177 -1
4 1 9 1 1 0 2238 604 10 1177 -1
5 1 9 1 1 1 2238 604 10 1177 95.000000
2 1 10 0 0 0 1492 607 11 1174 -1
3 1 10 1 0 0 1492 607 11 1174 -1
4 1 10 1 1 0 1492 607 11 1174 -1
5 1 10 1 1 1 1492 607 11 1174 95.000000
2 1 11 0 0 0 630 609 13 1176 -1
3 1 11 1 0 0 630 609 13 1176 -1
4 1 11 1 1 0 630 609 13 1176 -1
5 1 11 1 1 1 630 609 13 1176 95.000000
2 1 12 0 0 0 460 661 13 1127 -1
3 1 12 1 0 0 460 661 13 1127 -1
4 1 12 1 1 0 460 661 13 1127 -1
5 1 12 1 1 1 460 661 13 1127 95.000000
2 1 13 0 0 0 379 780 28 993 -1
3 1 13 1 0 0 379 780 28 993 -1
4 1 13 1 1 0 379 780 28 993 -1
5 1 13 1 1 1 381 1672 26 101 85.170807 ADNIN
5 1 13 1 1 2 375 1531 41 127 53.200932 &FANICY
5 1 13 1 1 3 375 1431 41 87 83.447807 COURT
5 1 13 1 1 4 375 1329 41 93 22.523050 STAFF.
5 1 13 1 1 5 379 999 26 312 75.203735 COMMISSIONERSTAFF
5 1 13 1 1 6 384 780 23 191 27.395887 [COMMISSIONER
2 1 14 0 0 0 633 1770 1613 18 -1
3 1 14 1 0 0 633 1770 1613 18 -1
4 1 14 1 1 0 633 1770 1613 18 -1
5 1 14 1 1 1 633 1770 1613 18 95.000000
2 1 15 0 0 0 319 1783 148 5 -1
3 1 15 1 0 0 319 1783 148 5 -1
4 1 15 1 1 0 319 1783 148 5 -1
5 1 15 1 1 1 319 1783 148 5 95.000000
2 1 16 0 0 0 634 1816 1612 20 -1
3 1 16 1 0 0 634 1816 1612 20 -1
4 1 16 1 1 0 634 1816 1612 20 -1
5 1 16 1 1 1 634 1816 1612 20 95.000000
2 1 17 0 0 0 465 1794 318 135 -1
3 1 17 1 0 0 465 1794 318 135 -1
4 1 17 1 1 0 465 1794 318 135 -1
5 1 17 1 1 1 465 1794 318 135 95.000000
2 1 18 0 0 0 2087 3029 214 33 -1
3 1 18 1 0 0 2087 3029 214 33 -1
4 1 18 1 1 0 2087 3029 214 33 -1
5 1 18 1 1 1 2087 3029 82 33 96.653938 Page
5 1 18 1 1 2 2180 3029 37 28 96.572151 16
5 1 18 1 1 3 2228 3029 30 28 96.109093 of
5 1 18 1 1 4 2265 3029 36 28 96.109093 20
2 1 19 0 0 0 2546 183 3 360 -1
3 1 19 1 0 0 2546 183 3 360 -1
4 1 19 1 1 0 2546 183 3 360 -1
5 1 19 1 1 1 2546 183 3 360 95.000000
Hourly Avalishle Mantaly Total VO Monthly
EXHIBIT B
SUB RECIPIENT INCENTIVE REPORT
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Child Support Services
41789 W Jefferson St, Phoenix, AZ 85007 MD 7217
SUB RECIPIENT INCENTIVE FORM
Sub Recipient (County) Name
Sub Recipient DUNS Number
Reporting Month
Incentive Fund Account Number
The purpose of this report is to provide information regarding the use of each sub recipient's portion
of their incentive dollars, Please provide only actual expenses that were paid with incentive dollars on
this report. This excludes ail {V-D dollars.
Please provide detailed explanation of what the expenditures in each section consist of under the
total In the explanation box.
Beginning Balance as of QE $ -
Prior Quarter Incentive Award
$
Expenditure Amount
.
1. Personal Services . . $ -
(Salaries, bonuses, stipends, education assistance)
Explanation Box:
2. Employee Related Services $ “
(Medical/Fringe benefits, Disability, etc.)
Explanation Box:
oa
3. Professional and Outside Services $ -
(Contractors, Education/training from vendor, etc.)
Explanation Box:
4. Travel Expenses $ -
(Mileage, Meals, Lodging, Airfare)
a Mileage
bMeals
c Lodging
d Airfare
Explanation Box:
Page 17 of 20
EXHIBIT B
SUS RECIPIENT INCENTIVE FORM
5. Operating Expenses $ -
(Risk Management, Postage, Telecommunications, etc.)
Explanation Box:
6, Occupancy $ -
(Space, rent, etc.)
a. Square feet $ -
b. Rate $ -
Explanation Box:
Non-Capital Furniture
$
(Furniture purchases under $5,000)
Explanation Box:
Capital Furniture
$ -
(Furniture purchases above $5,000)
Explanation Box:
Indirect Administrative Costs
$
(Cost allocated charges)
Explanation Box:
Total Actual Expenditures for Reporting Period $ .
,
Ending Balance as of QE $ -
CERTIFICATION: | certify, under penalties of perjury, that this Incentives Report State has been
examined by me and, to the best of my knowledge and belief, It Is a true, correct and valid claim
against the State of Arizona. ;
Authorized Signature Title Date
Administration for Children and Families (OCSE) References/Links:
Incentives Purpose:
https://www.acf.hhs.gov/css/resource/child-sup port-Incentive-funding
. Page 18 of 20
EXHIBIT B
SUB REGIPIENT INCENTIVE FORM
Incentives background (Allowable/Non-Allowable expenses):
https://www.aef.hhs.gov/css/resource/reinvestment-of-child-support-incentive -
Equal Opportunity Employer/Program + Under Titles Vi and Vit of the Civil Rights Act of 1964 (Title VI &
Vil}, and the Americans with Disabilittes Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973,
the Age Discrimination Act of 1975, and Title Ii of the Genetic Information Nondiscrimination Act (GINA) of
2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment
based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. To request this
document in alternative format or for further information about this policy, contact your tacal office;
TTY/TDD Services: 7-44. « Free language assistance for DES services Is avallable upon request.
Disponible en espafiol en linea 0 en a oficina local.