1. El Monte-15BCTS26Q00000007.pdf

U. S. Department of Justice

Federal Bureau of Prisons

Washington, D.C. 20534

October 27, 2026

Re: 15BCTS26Q00000007, El Monte, California

All Interested Parties:

This Request for Quotation (RFQ) is to provide Substance Abuse and Mental Health Treatment services for male and female offenders held under authority of the United States in El Monte, California. Services are to be provided in accordance with the enclosed Statement of Work entitled, “Community Treatment Services (CTS), 2022 Statement of Work (SOW)”

The following must be completed and submitted with your Quotation:

Standard Form (SF) 1449 - Solicitation/Contract/Order for Commercial Items - Please complete blocks 12,17a, 17b, 23, 24, 30a, 30b, and 30c, of the SF-1449 and the continuation sheets. Please include your telephone number in Block 17a. Original signatures are required.

Required Documentation Identified at FAR 52.212-1, Instructions to Offerors- Commercial Products and Commercial Services (Nov 2025)(Deviation). The Government intends to evaluate offers and award a contract without discussions with Offerors. Therefore, the Offeror’s initial offer should contain the Offeror’s best terms.

However, the Government reserves the right to conduct discussions, if necessary. The Government may reject any or all offers if such action is in the public interest, accept other than the lowest offer, and waive informalities and minor irregularities in offers received.

Quotes will only be accepted via email yramos-maness@bop.gov. Please include SEPARATE FILE ATTACHMENTS for the following:

Completed SF-1449 Completed Attachment Quotation Form Completed Business Quotation Information Packet Completed Technical Quotation Information Packet Completed Pricing Chart Completed ATU Attestation Form

Proof of completed SAM registration (must be active by time of quotation submission)

A copy of your current Professional Liability Insurance

Quotations shall be received by November 16, 2026, 2:00 P.M. EST to yramos-maness@bop.gov. Please confirm that all emails and attachments are received.

The solicitation will be distributed solely through the General Services Administration’s www.sam.gov website. Hard copies of the solicitation document will not be available. The website provides downloading instructions. All future information about this solicitation, including solicitation amendments, will be solely distributed through this website. Interested parties are responsible for monitoring this website to ensure they have the most up-to-date information about this solicitation.

Please direct any questions to yramos-maness@bop.gov.

Respectfully, Yasmin Ramos-Maness Contracting Officer

15BCTS26Q00000007 Page 1 of 46

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

15BCTS26Q00000007

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

10/27/2026

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Yasmin Ramos-Maness yramos-maness@bop.gov

b. TELEPHONE NUMBER (No collect calls)

202-598-5872

8. OFFER DUE DATE / LOCAL

TIME

11/16/2026 14:00 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

Yasmin Ramos-Maness

(O) 202-598-5872 yramos-maness@bop.gov

FACILITY

CODE

CODE

TELEPHONE NUMBER

17a. CONTRACTOR/

OFFEROR

15B600CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons Western Regional Office

7338 SHORELINE DRIVE

STOCKTON, CA 95219

BOP-RSD-CRBCTS-BILL-LA-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: 01/01/2027

Substance Use and Mental Health Treatment Services in El Monte, California.

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)

Yasmin Ramos-Maness

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

007-26

15BCTS26Q00000007 Page 2 of 46

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

15BCTS26Q00000007 Page 3 of 46

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) 52.203-13 Contractor Code of Business Ethics and Conduct (Nov 2021) 52.203-17 Contractor Employee Whistleblower Rights (Nov 2023) 52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014) 52.204-91 (DEV) Contractor Identification (DEVIATION NOV 2025) 52.209-6 (DEV) Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded (Jan 2025)

(DEVIATION NOV 2025)

52.209-9 (DEV) Updates of Publicly Available Information Regarding Responsibility Matters (Oct 2018) (DEVIATION NOV 2025) 52.209-10 (DEV) Prohibition on Contracting With Inverted Domestic Corporations (Nov 2015)

(DEVIATION NOV 2025)

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

2023) (DEVIATION NOV 2025)

52.219-6 (DEV) Notice of Total Small Business Set-Aside (Nov 2020) (DEVIATION DEC 2025) 52.219-8 (DEV) Utilization of Small Business Concerns (Jan 2025) (DEVIATION DEC 2025) 52.222-3 (DEV) Convict Labor (June 2003) (DEVIATION DEC 2025) 52.222-19 (DEV) Child Labor-Cooperation with Authorities and Remedies (Jan 2025)

(DEVIATION MAR 2026)

52.222-35 (DEV) Equal Opportunity for Veterans (Jun 2020) (DEVIATION DEC 2025) 52.222-36 (DEV) Equal Opportunity for Workers with Disabilities (Jun 2020) (DEVIATION

DEC 2025)

52.222-37 (DEV) Employment Reports on Veterans (Jun 2020) (DEVIATION DEC 2025) 52.222-40 (DEV) Notification of Employee Rights Under the National Labor Relations Act (Dec

2010) (DEVIATION DEC 2025)

52.222-41 (DEV) Service Contract Labor Standards (Aug 2018) (DEVIATION DEC 2025) 52.222-50 (DEV) Combating Trafficking in Persons (Oct 2025) (DEVIATION DEC 2025) 52.222-54 (DEV) Employment Eligibility Verification (Jan 2025) (DEVIATION DEC 2025) 52.222-90 Addressing DEI Discrimination by Federal Contractors (APR 2026) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.224-3 Privacy Training (Jan 2017) 52.226-8 Encouraging Contractor Policies To Ban Text Messaging While Driving (May 2024) 52.232-33 Payment by Electronic Funds Transfer-System for Award Management (Oct 2018) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.233-3 (DEV) Protest after Award (Aug 1996) (DEVIATION NOV 2025) 52.233-4 (DEV) Applicable Law for Breach of Contract Claim (Oct 2004) (DEVIATION NOV 2025) 52.240-91 (DEV) Security Prohibitions and Exclusions (DEVIATION NOV 2025) 52.240-93 (DEV) Basic Safeguarding of Covered Contractor Information Systems

(DEVIATION NOV 2025)

52.242-13 Bankruptcy (July 1995) 52.242-15 Stop-Work Order (Aug 1989) 52.252-6 Authorized Deviations in Clauses (Nov 2020) 52.253-1 (DEV) Computer Generated Forms (Jan 1991) (DEVIATION NOV 2025)

15BCTS26Q00000007 Page 4 of 46

52.203-6 Alt I Restrictions on Subcontractor Sales to the Government (Jun 2020) - Alternate I (Nov 2021) 52.204-13 (DEV) System for Award Management-Maintenance (Oct 2018) (DEVIATION NOV 2025) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 (DEV) Indefinite Quantity (Oct 1995) (DEVIATION DEC 2025) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.219-28 (DEV) Postaward Small Business Program Rerepresentation (Jan 2025)

(DEVIATION DEC 2025)

52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 (DEV) Indemnification and Medical Liability Insurance (Jan 1997) (DEVIATION NOV 2025) BOP 2852.201-71 Contracting Officer's Representative (COR) (June 2012)

BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS

(APR 2011)

BOP DOJ-05 DEVIATION BOP-05 Security of Department Information and Systems (January 2025) 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)

3 List of Attachments 4 Solicitation Provisions

52.212-1 (DEV) Instructions to Offerors-Commercial Products and Commercial Services (Sep

2023) (DEVIATION NOV 2025)

52.203-11 Certification And Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2024) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-7 (DEV) System for Award Management-Registration (Nov 2024) (DEVIATION NOV 2025) 52.217-5 (DEV) Evaluation of Options (July 1990) (DEVIATION AUG 2025) 52.219-4 (DEV) Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Oct 2022) (DEVIATION DEC 2025) 52.233-2 (DEV) Service of Protest (Sep 2006) (DEVIATION NOV 2025) 52.240-90 (DEV) Security Prohibitions and Exclusions Representations and Certifications

(DEVIATION NOV 2025)

2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020) 52.209-11 (DEV) Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb 2016) (DEVIATION NOV 2025) 52.216-1 (DEV) Type of Contract (Apr 1984) (DEVIATION DEC 2025)

15BCTS26Q00000007 Page 5 of 46

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)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Disorder Individual Counseling (2010)

60 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Co-occurring Intake Assessment & Report (2012)

2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

40 EA $________ $_________________

15BCTS26Q00000007 Page 6 of 46

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

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

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Base Period: 1 month through 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

0010 Mental Health Intake Assessment & Report (5011)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

60 EA $________ $_________________

15BCTS26Q00000007 Page 7 of 46

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Psychiatric Evaluation & Report (5030)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Base Period: 1 month through 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)

60 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Base Period: 1 month through 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)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 MH- Medication Monitoring & Reporting (6051)

4 Units Guaranteed Minimum; 120 Units Estimated Maximum

Base Period: 1 month through 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS26Q00000007 Page 8 of 46

0016 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Substance Use Disorder Individual Counseling (2010)

60 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Co-occurring Intake Assessment & Report (2012)

2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 1: 13 months through 24 months

4,800 EA $________ $_________________

15BCTS26Q00000007 Page 9 of 46

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Mental Health Treatment Planning and Follow-up (5001)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 1: 13 months through 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

0025 Mental Health Intake Assessment & Report (5011)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Psychiatric Evaluation & Report (5030)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS26Q00000007 Page 10 of 46

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 1: 13 months through 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

0028 Mental Health Individual Counseling (6010)

60 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Option Year 1: 13 months through 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

0029 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 MH- Medication Monitoring & Reporting (6051)

4 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS26Q00000007 Page 11 of 46

0032 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Substance Use Disorder Individual Counseling (2010)

60 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Co-occurring Intake Assessment & Report (2012)

2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 2: 25 months through 36 months

36 EA $________ $_________________

15BCTS26Q00000007 Page 12 of 46 amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Mental Health Treatment Planning and Follow-up (5001)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 2: 25 months through 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

0040 Mental Health Intake Assessment & Report (5011)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Psychiatric Evaluation & Report (5030)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

10 EA $________ $_________________

15BCTS26Q00000007 Page 13 of 46

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Mental Health Individual Counseling (6010)

60 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Option Year 2: 25 months through 36 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

0044 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 MH- Medication Monitoring & Reporting (6051)

4 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 2: 25 months through 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS26Q00000007 Page 14 of 46

0048 Substance Use Disorder Individual Counseling (2010)

60 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 3: 37 months through 48 monthss

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Co-occurring Intake Assessment & Report (2012)

2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Mental Health Treatment Planning and Follow-up (5001)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS26Q00000007 Page 15 of 46 amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 3: 37 months through 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

0055 Mental Health Intake Assessment & Report (5011)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Psychiatric Evaluation & Report (5030)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 3: 37 months through 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

0058 Mental Health Individual Counseling (6010)

60 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

1,200 EA $________ $_________________

15BCTS26Q00000007 Page 16 of 46

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 MH- Medication Monitoring & Reporting (6051)

4 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 3: 37 months through 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Substance Use Disorder Individual Counseling (2010)

60 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS26Q00000007 Page 17 of 46

0064 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Co-occurring Intake Assessment & Report (2012)

2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

36 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Mental Health Treatment Planning and Follow-up (5001)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 4: 49 months through 60 months

50 EA $________ $_________________

15BCTS26Q00000007 Page 18 of 46 amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Mental Health Intake Assessment & Report (5011)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Psychiatric Evaluation & Report (5030)

4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 4: 49 months through 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

0073 Mental Health Individual Counseling (6010)

60 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Option Year 4: 49 months through 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

0074 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 36 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

36 EA $________ $_________________

15BCTS26Q00000007 Page 19 of 46

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 MH- Medication Monitoring & Reporting (6051)

4 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 4: 49 months through 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Substance Use Disorder Treatment Planning and Follow-up (2001)

4 Units Guaranteed Minimum; 40 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Substance Use Disorder Intake Screening (2005)

1 Unit Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Substance Use Disorder Individual Counseling (2010)

30 Units Guaranteed Minimum; 900 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Substance Use Disorder Intake Assessment & Report (2011)

4 Units Guaranteed Minimum; 40 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS26Q00000007 Page 20 of 46

0080 Co-occurring Intake Assessment & Report (2012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Substance Use Disorder Group Counseling (2020)

60 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Substance Use Disorder Relationship and Parenting Counseling (2030)

1 Unit Guaranteed Minimum; 18 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

18 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Mental Health Treatment Planning and Follow-up (5001)

2 Units Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Mental Health Intake Screening (5005)

1 Unit Guaranteed Minimum; 25 Units Estimated Maximum

Potential 6 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

0085 Mental Health Intake Assessment & Report (5011)

2 Units Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

30 EA $________ $_________________

15BCTS26Q00000007 Page 21 of 46 amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Psychiatric Evaluation & Report (5030)

2 Units Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 5 Units Estimated Maximum

Option Year 1: 13 months through 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Mental Health Individual Counseling (6010)

30 Units Guaranteed Minimum; 600 Units Estimated Maximum

Potential 6 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

0089 Mental Health Relationship and Parenting Counseling (6031)

1 Unit Guaranteed Minimum; 18 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

18 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 MH- Medication Monitoring & Reporting (6051)

2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Potential 6 Month Extension

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS26Q00000007 Page 22 of 46

Section 2 - Contract Clauses

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

2023) (DEVIATION NOV 2025)

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)

52.203-13 Contractor Code of Business Ethics and Conduct (Nov

2021)

52.203-17 Contractor Employee Whistleblower Rights (Nov 2023)

52.204-19 Incorporation by Reference of Representations and

Certifications (Dec 2014)

52.204-91 (DEV) Contractor Identification (DEVIATION NOV 2025)

52.209-6 (DEV) Protecting the Government's Interest When

Subcontracting with Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded (Jan

2025) (DEVIATION NOV 2025)

52.209-9 (DEV) Updates of Publicly Available Information Regarding

Responsibility Matters (Oct 2018) (DEVIATION NOV

2025)

52.209-10 (DEV) Prohibition on Contracting With Inverted Domestic

Corporations (Nov 2015) (DEVIATION NOV 2025)

15BCTS26Q00000007 Page 23 of 46

Clause Title Fill-ins (if applicable)

52.212-4 (DEV) Terms and Conditions-Commercial Products and

Commercial Services (Nov 2023) (DEVIATION NOV

2025)

52.219-6 (DEV) Notice of Total Small Business Set-Aside (Nov 2020)

(DEVIATION DEC 2025)

52.219-8 (DEV) Utilization of Small Business Concerns (Jan 2025)

(DEVIATION DEC 2025)

52.222-3 (DEV) Convict Labor (June 2003) (DEVIATION DEC 2025)

52.222-19 (DEV) Child Labor-Cooperation with Authorities and Remedies

(Jan 2025) (DEVIATION MAR 2026)

52.222-35 (DEV) Equal Opportunity for Veterans (Jun 2020) (DEVIATION

DEC 2025)

52.222-36 (DEV) Equal Opportunity for Workers with Disabilities (Jun

2020) (DEVIATION DEC 2025)

52.222-37 (DEV) Employment Reports on Veterans (Jun 2020)

(DEVIATION DEC 2025)

52.222-40 (DEV) Notification of Employee Rights Under the National

Labor Relations Act (Dec 2010) (DEVIATION DEC

2025)

52.222-41 (DEV) Service Contract Labor Standards (Aug 2018)

(DEVIATION DEC 2025)

52.222-50 (DEV) Combating Trafficking in Persons (Oct 2025)

(DEVIATION DEC 2025)

52.222-54 (DEV) Employment Eligibility Verification (Jan 2025)

(DEVIATION DEC 2025)

52.222-90 Addressing DEI Discrimination by Federal Contractors

(APR 2026)

52.224-1 Privacy Act Notification (Apr 1984)

52.224-2 Privacy Act (Apr 1984)

52.224-3 Privacy Training (Jan 2017)

15BCTS26Q00000007 Page 24 of 46

Clause Title Fill-ins (if applicable)

52.226-8 Encouraging Contractor Policies To Ban Text

Messaging While Driving (May 2024)

52.232-33 Payment by Electronic Funds Transfer-System for

Award Management (Oct 2018)

52.232-40 Providing Accelerated Payments to Small Business

Subcontractors (Mar 2023)

52.233-3 (DEV) Protest after Award (Aug 1996) (DEVIATION NOV 2025)

52.233-4 (DEV) Applicable Law for Breach of Contract Claim (Oct 2004)

(DEVIATION NOV 2025)

52.240-91 (DEV) Security Prohibitions and Exclusions (DEVIATION NOV

2025)

52.240-93 (DEV) Basic Safeguarding of Covered Contractor Information

Systems (DEVIATION NOV 2025)

52.242-13 Bankruptcy (July 1995)

52.242-15 Stop-Work Order (Aug 1989)

52.252-6 Authorized Deviations in Clauses (Nov 2020) Regulation Name: "FAR provision or clause deviations"

CFR: "Chapter 1"

52.253-1 (DEV) Computer Generated Forms (Jan 1991) (DEVIATION

NOV 2025)

52.203-6 Alt I Restrictions on Subcontractor Sales to the Government

(Jun 2020) - Alternate I (Nov 2021)

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

(DEVIATION NOV 2025)

Clauses By Full Text

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):

15BCTS26Q00000007 Page 25 of 46 https://www.acquisition.gov/ [Insert one or more Internet addresses]

(End of clause)

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 start of performance period through end of performance 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 $1.00 [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];

(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.

15BCTS26Q00000007 Page 26 of 46

(End of clause)

52.216-22 (DEV) Indefinite Quantity (Oct 1995) (DEVIATION DEC 2025)

(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 ordering period of this contract and not completed within that period shall be completed by the Contractor within the time…