interrelated roles of the CSU, CSC and/or Temp/Obs as a program is designed as an alternative and/or diversion to hospitalization; Fire Safety Documentation; Documentation of the agency accreditation as required by Departmental policy; most recent Copy of a Commercial General Liability or Comprehensive Liability Insurance Certificate; current a copy of the organizational chart of the If changes have occurred since initial application, current agency; a If there has been a change in CEO, or if an affidavit has never been submitted by the current CEO, signed and notarized U.S. Citizen/Qualified Alien Affidavit, with required documentation.
interrelated roles of the CSU, CSC and/or Temp/Obs as a program is designed as an alternative and/or diversion to hospitalization; Fire Safety Documentation; Documentation of the most recent agency accreditation as required by Departmental policy; Copy of a current Commercial General Liability or Comprehensive Liability Insurance Certificate; If changes have occurred since initial application, a current copy of the organizational chart of the agency; If there has been a change in CEO, or if an affidavit has never been submitted by the current CEO, a signed and notarized U.S. Citizen/Qualified Alien Affidavit, with required documentation.
CSU_Application_for_Renewal_%20Revised%202.27.15.docx