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CA-1210A FORNA (4-16) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Page 1 of 1 Child Care Administration (CCA) SIGNATURE PAGE FOR THE CHILD CARE PROVIDER REGISTRATION AGREEMENT Between the Department of Economic Security (ADES) which is duly authorized to execute and administer Registration Agreements under A.R.S. § 41-1954; and the Child Care Provider (Provider or Contractor) Maricopa County Human Services - Valor on 8th DHS/Tribal/Military Licensee or Certificate Holder 1001 E. 8th Street, Tempe, Arizona 85281 (602) 565-7431 Mailing Address (No., Street, City, State, Zip Code) Area Code / Phone Number This Agreement to provide child care services as defined in A.A.C. R6-5-4901(8), as amended, shall begin on 11/27/2023 , or date of last signature, whichever is later, and shall terminate on 09/30/2026 . . ADES enters effective date The Child Care Provider shall address all notices relative to this Agreement electronically or by mail to: Arizona Department of Economic Security Child Care Administration P. O. Box 6123 – Mail Drop 5474 Phoenix, AZ 85007 Email: CCAContracts@azdes.gov ____________________________________________________________________________________________________________ I hereby certify, under penalties of perjury, that I have the legal right to enter into this Agreement or am legally empowered with the authority, whether expressed, implied, or apparent, to bind my principal or employer by this Agreement. FOR AND ON BEHALF OF THE ARIZONA DEPARTMENT OF ECONOMIC SECURITY: FOR AND ON BEHALF OF THE CONTRACTED CHILD CARE PROVIDER: 9/20/2023 Signature Date Jacqueline Edwards Michelle Genaro, DCC, Deputy Assistant Director Type or Print Name and Title of Authorized Signer SX241111 86-6000472 ADES Assigned Contract Number EIN Number or Social Security Number P0028668226 ADES Assigned Provider ID Number Print name and title of alternate person(s) authorized to sign this Agreement and any amendments for the signer listed above, if the signer is not available. 11/29/2023 Jacqueline Edwards/ Human Services Director Date Signed by ADES Child Care Administration Type or Print Name/Title of Alternate Person Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities 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. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact 602-542-4248; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Disponible en español en la oficina local. FOR DES USE ONLY: Month and year entered to this section indicate the actual month and year DES made the provider’s rate revision effective: 11/27/2023 CC-214 (9-21) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Child Care Administration CHILD CARE PROVIDER RATE AGREEMENT Please read the reverse for additional information. Provider/Facility’s Name Maricopa County Human Services - Valor on 8th Provider Number P0028668226 √ Initial Rate Notification 1. Complete and submit original and canary copy of this agreement (faxed copies are unacceptable). 2. Rate revision only: (ALL RATE REVISIONS SHALL BE EFFECTIVE ON THE FIRST DAY OF THE MONTH.) Provider shall submit the Child Care Provider Rate Agreement a minimum of 30 days prior to the proposed effective date of any changes to the Child Care Provider’s rates. Enter the month and year your proposed rate revision will begin 9/20/2023 (Month and year entered may not be the same month and year DES makes rates effective.) 3. Rates entered in the “PROVIDER’S RATE” column below must be your normal and customary charges. Information Regarding the DES Reimbursement Rates: 1. The DES will pay the rates indicated in the shaded area entitled RATES AUTHORIZED BY DES minus any DES required customer co-payment. (Co-payment: An amount established by DES requiring families to pay to the provider.) 2. The DES shall review its provider’s rates, complete the shaded areas, sign the Agreement, and return the canary copy to the provider. DES shall maintain the original in the provider’s file. 3. Reimbursement rates authorized by DES under this Agreement may be revised through a fully executed Child Care Provider Rate Agreement or upon thirty (30) days written notice to the provider of the revised reimbursement rates established by DES. DO NOT LIST HOURLY, WEEKLY, OR MONTHLY RATES. RATES ENTERED BELOW SHOULD BE A FULL DAY DAILY RATE AND/OR A PART DAY DAILY RATE. DO NOT ENTER INFORMATION TO SHADED AREAS. DES USE ONLY AGE GROUPS PROVIDER’S RATES *RATES AUTHORIZED BY DES Do not change age groups below. Full Day (6 hrs or more) Part Day (Less than 6 hrs) Full Day (6 hrs or more) Part Day (Less than 6 hrs) BP Eligibility (P Kind) Preschool: Three (3), Four (4), Five (5) years- old $64.68 $40.80 $40.80 National Accreditation No Star Rating *Incentive rates are subject to change. DES Authorized Representative’s Signature: Michelle Genaro, Deputy Assistant Director, Division of Child Care Date:11/29/2023