0.a. 15BCTS25Q00000011.pdf

15BCTS25Q00000011 Page 1 of 68

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 AND 30.

1. REQUISITION NUMBER PAGE 1 OF

5. SOLICITATION NUMBER

15BCTS25Q00000011

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

08/26/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Coretta MaGee cmagee@bop.gov

b. TELEPHONE NUMBER (No collect calls)

202-598-6114

8. OFFER DUE DATE / LOCAL

TIME

09/25/2025 12:00 ET

CODE 15BCTS

Federal Bureau of Prisons

Community Treatment Services Contracting

320 First Street NW

Suite 901-5

Washington, DC 20534

9. ISSUED BY UNRESTRICTED OR X SET ASIDE:100.00 % FOR

X SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL BUSINESS

(EDWOSB)

8(A)

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

621420

SIZE STANDARD:

19,000,000

10. THE ACQUISITION IS

SEE SCHEDULE

11. DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER THE

DEFENSE PRIORITIES AND

ALLOCATIONS SYSTEM -

DPAS (15 CFR 700)

13b. RATING

X REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

14. METHOD OF SOLICITATION

CODE15. DELIVER TO CODE 15BCTS16. ADMINISTERED BY

Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534

Coretta MaGee

(O) 202-598-6114 cmagee@bop.gov

FACILITY

CODE

CODE

TELEPHONE NUMBER

17a. CONTRACTOR/

OFFEROR

15B200CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons Northeast Regional Office

US CUSTOM HOUSE, 7TH FLOOR

2ND & CHESTNUT

Philadelphia, PA 19106

BOP-RSD-CRBCTS-BILL-PHL-S@bop.gov

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Delivery Date: 11/01/2025

Outpatient Substance Use Disorder (SU) & Mental Health (MH) Services in Cleveland, OH Firm Fixed Price

See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

ARE X ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REFERENCE _____________________________

OFFER DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK

5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (Type or print)

Coretta MaGee

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

021-25

Federal Bureau of Prisons Northeast Regional Office

US CUSTOM HOUSE, 7TH FLOOR

2ND & CHESTNUT

Philadelphia, PA 19106

15B200

15BCTS25Q00000011 Page 2 of 68

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 11/2021) BACK

15BCTS25Q00000011 Page 3 of 68

Table of Contents

Section Description Page Number

Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses

52.203-3 Gratuities (Apr 1984) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.242-13 Bankruptcy (July 1995) 52.242-15 Stop-Work Order (Aug 1989) 52.253-1 Computer Generated Forms (Jan 1991) 52.252-6 Authorized Deviations in Clauses (Nov 2020) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS

(APR 2011)

DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency (OCT 2007) 52.212-5 (DEV) Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (Jan 2025) (DEVIATION FEB 2025) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)...

52.217-9 Option to Extend the Term of the Contract (Mar 2000)

3 List of Attachments 4 Solicitation Provisions

52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-7 System for Award Management (Nov 2024) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.217-5 Evaluation of Options (July 1990) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.216-1 Type of Contract (Apr 1984) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020)

15BCTS25Q00000011 Page 4 of 68

52.212-3 (DEV) Offeror Representations and Certifications-Commercial Products and Commercial Services (May 2024) (DEVIATION FEB 2025)

15BCTS25Q00000011 Page 5 of 68

Section 1 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0001 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 200 Estimated Maximum Quantity: 2800

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50

50 EA $________ $_________________

15BCTS25Q00000011 Page 6 of 68

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 400 Estimated Maximum Quantity: 7200

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

7,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 75

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Base Year: Date of award - 12 months

110 EA $________ $_________________

15BCTS25Q00000011 Page 7 of 68

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

10 EA $________ $_________________

15BCTS25Q00000011 Page 8 of 68

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 200

Base Year: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 200 Estimated Maximum Quantity: 2800

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

150 EA $________ $_________________

15BCTS25Q00000011 Page 9 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 400 Estimated Maximum Quantity: 7200

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

7,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 75

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

75 EA $________ $_________________

15BCTS25Q00000011 Page 10 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

100 EA $________ $_________________

15BCTS25Q00000011 Page 11 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 200

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum Quantity: 200 Estimated Maximum Quantity: 2800

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

2,800 EA $________ $_________________

15BCTS25Q00000011 Page 12 of 68

ITEM NO. SUPPLIES/SERVICES EST. UNIT UNIT PRICE AMOUNT

0036 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum; Quantity: 10 Estimated Maximum Quantity: 150

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 400 Estimated Maximum Quantity: 7200

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

7,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25Q00000011 Page 13 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 75

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

1,200 EA $________ $_________________

15BCTS25Q00000011 Page 14 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 200

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

50 EA $________ $_________________

15BCTS25Q00000011 Page 15 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 200 Estimated Maximum Quantity: 2800

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 400 Estimated Maximum Quantity: 7200

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

7,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25Q00000011 Page 16 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 75

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

10 EA $________ $_________________

15BCTS25Q00000011 Page 17 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 200

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

150 EA $________ $_________________

15BCTS25Q00000011 Page 18 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 200 Estimated Maximum Quantity: 2800

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 150

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

150 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 400 Estimated Maximum Quantity: 7200

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

7,200 EA $________ $_________________

15BCTS25Q00000011 Page 19 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 75

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

110 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 110

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25Q00000011 Page 20 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 200

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

200 EA $________ $_________________

15BCTS25Q00000011 Page 21 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

25 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 1400

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

25 EA $________ $_________________

15BCTS25Q00000011 Page 22 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 200 Estimated Maximum Quantity: 3600

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

3,600 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 55

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

55 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 38

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

38 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 55

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

55 EA $________ $_________________

15BCTS25Q00000011 Page 23 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 55

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

55 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 600

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

600 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

5 EA $________ $_________________

15BCTS25Q00000011 Page 24 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100

Potential Six-Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25Q00000011 Page 25 of 68

Section 2 - Contract Clauses

A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023)

The terms and conditions for the following clauses are hereby incorporated into this solicitation and resulting contract as an addendum to FAR clause 52.212-4.

Clauses By Reference

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.acquisition.gov

Clause Title Fill-ins (if applicable)

52.203-3 Gratuities (Apr 1984)

52.203-12 Limitation On Payments to Influence Certain Federal

Transactions (Jun 2020)

52.204-12 Unique Entity Identifier Maintenance (Oct 2016)

52.204-13 System for Award Management Maintenance (Oct 2018)

52.204-18 Commercial and Government Entity Code Maintenance

(Aug 2020)

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023)

52.224-1 Privacy Act Notification (Apr 1984)

52.224-2 Privacy Act (Apr 1984)

52.242-13 Bankruptcy (July 1995)

52.242-15 Stop-Work Order (Aug 1989)

52.253-1 Computer Generated Forms (Jan 1991)

52.252-6 Authorized Deviations in Clauses (Nov 2020)

Clauses By Full Text

15BCTS25Q00000011 Page 26 of 68

52.21-603-70 Contracting Officer's Representative (COR) (June 2012)

(a)Sandra Hargesheimer, SCTC Lead, COR, Cynthia Benik, Ashanti Black, La'Kendra Curry, Sabina Medvinsky, Ewelina Rozkuszka, and Mayelin Ugarte ,U.S. Custom House - 4th Fl, 200 Chestnut Street, Philadelphia, PA 19106 ,(202) 305-5423, (202) 451-7227, (202) 451-7225, (202) 893-5331, (202) 451-7226, (202) 451-7228, (202) 598# 9246, is hereby designated as the Contracting Officer's Representative (COR) under this contract.

(b)The COR is responsible, as applicable, for: receiving all deliverables, inspecting and accepting the supplies or services provide hereunder in accordance with the terms and conditions of this contract; providing direction to the contractor which clarifies the contractor effort, fills in details or otherwise serves to accomplish the contractual Scope of Work; evaluating performance; and certifying all invoices/vouchers for acceptance of the supplies or services furnished for payment.

(c)The COR does not have the authority to alter the contractor's obligations under the contract, and/or modify any of the expressed terms, conditions, specifications, or cost of the agreement. If as a result of technical discussions it is desirable to alter/change contractual obligations or the Scope of Work, the Contracting Officer shall issue such changes.

52.216-18 Ordering (Aug 2020)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from first day of the contract's effective period through the last day of the contract's effective period [insert dates].

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) A delivery order or task order is considered "issued" when--

(1) If sent by mail (includes transmittal by U.S. mail or private delivery service), the Government deposits the order in the mail;

(2) If sent by fax, the Government transmits the order to the Contractor's fax number; or

(3) If sent electronically, the Government either--

(i) Posts a copy of the delivery order or task order to a Government document access system, and notice is sent to the Contractor; or

(ii) Distributes the delivery order or task order via email to the Contractor's email address.

(d) Orders may be issued by methods other than those enumerated in this clause only if authorized in the contract.

(End of clause)

52.216-19 Order Limitations (Oct 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than one [insert dollar figure or quantity], the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor--

(1) Any order for a single item in excess of the estimated quantities identified on the SF-1449 (Block 21, Quantity) within the current contract performance period [insert dollar figure or quantity];

15BCTS25Q00000011 Page 27 of 68

(2) Any order for a combination of items in excess of the estimated quantities identified on the SF-1449 (Block 21, Quantity) within the current contract performance period [insert dollar figure or quantity]; or

(3) A series of orders from the same ordering office within 30 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section.

(c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section.

(d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 7 days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

(End of clause)

52.216-22 Indefinite Quantity (Oct 1995)

(a) This is an indefinite-quantity contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies and services specified in the Schedule are estimates only and are not purchased by this contract.

(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause.

The Contractor shall furnish to the Government, when and if ordered, the supplies or services specified in the Schedule up to and including the quantity designated in the Schedule as the "maximum." The Government shall order at least the quantity of supplies or services designated in the Schedule as the "minimum."

(c) Except for any limitations on quantities in the Order Limitations clause or in the Schedule, there is no limit on the number of orders that may be issued. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(d) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after the last day of the contract's effective period [insert date].

(End of clause)

52.217-8 Option to Extend Services (Nov 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within the current performance period [insert the period of time within which the Contracting Officer may exercise the option].

(End of clause)

52.232-18 Availability of Funds (Apr 1984)

Funds are not presently available for this contract. The Government's obligation under this contract is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise until funds are made available to the Contracting Officer for this contract and until the Contractor receives notice of such availability, to be confirmed in writing by the Contracting Officer.

(End of clause)

15BCTS25Q00000011 Page 28 of 68

52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984)

Funds are not presently available for performance under this contract beyond September 30 of the Base Year or any option year exercised. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond September 30 of the Base Year or any option year exercised, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

(End of clause)

52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

(a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor's professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: *1 million.

(b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause.

(c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided.

(d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer.

(e) The policies evidencing required insurance shall also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer…