15BCTS21Q00000019 Updated.pdf
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15BCTS21Q00000019 Page 1 of 71
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30
1. REQUISITION NUMBER
5. SOLICITATION NUMBER
15BCTS21Q00000019
2. CONTRACT NO. 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
12/02/2020
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Shuwona Jones Sjones2@bop.gov
b. TELEPHONE NUMBER (No collect calls)
202-616-9758
8. OFFER DUE DATE / LOCAL
TIME
12/16/2020 12:00 ET
CODE 15BCTS
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Room 901-5 Washington, DC 20534
9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS: 621420
SIZE STANDARD: $16,500,000
10. THE ACQUISITION IS
SEE
SCHEDULE
11. DELIVERY FOR FOB DESTINATION
UNLESS BLOCK IS MARKED
NET 30
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER DPAS
(15 CFR 700)
13b. RATING
X RFQ IFB RFP
14. METHOD OF SOLICITATION
15B200CODE15. DELIVER TO
Federal Bureau of Prisons Kansas Office
400 STATE AVENUE
SUITE 800
KANSAS CITY, KS 66101
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Room 901-5 Washington, DC 20534
Shuwona Jones
(O) 202-616-9758 sjones2@bop.gov
FACILITY
CODE
CODE
TELEPHONE NO.
17a. CONTRACTOR/
OFFEROR
15B200CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons Kansas Office
400 STATE AVENUE
SUITE 800
KANSAS CITY, KS 66101
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 NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
Substance Use, Mental Health, and Sex Offender Treatment Services in Great Falls, MT.
See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)
X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE 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: REF. _____________________________ 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) 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 2/2012)
Prescribed by GSA - FAR (48 CFR) 53.212
02/01/2021
019-21
15BCTS21Q00000019 Page 2 of 71
19.
ITEM NO.
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. 2/2012) BACK
15BCTS21Q00000019 Page 3 of 71
Table of Contents
Section Description Page Number
1 Solicitation/Contract Form 2 Commodity or Services Schedule 3 Contract Clauses
52.21-603-70 Contracting Officer's Representative (COR) (June 2012)
52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE
2004)
52.218-000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA
OR OTHER NATIONAL EMERGENCY (May 2008) DJAR-PGD-15-03 Security of Department Information and Systems 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-21 Requirements (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) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (June 2016) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders- Commercial Items (Nov 2020)
4 List of Attachments 5 Solicitation Provisions
52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Oct 2020) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.212-3 Offeror Representations and Certifications-Commercial Items (Nov 2020) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (Jan 1998)
52.27-103-71 FAITH-BASED AND COMMUNITY-BASED ORGANIZATIONS (AUG 2005)
52.216-1 Type of Contract (Apr 1984) 52.217-5 Evaluation of Options (July 1990)
15BCTS21Q00000019 Page 4 of 71
Section 2 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Intake - Substance Use (2005) (one per inmate) for Estimated 30 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 30 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 45 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
2,160 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 45 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
3,240 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 45 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,080 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS21Q00000019 Page 5 of 71
0006 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 30 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 7 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
42 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 7 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
42 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 7 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,176 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 7 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,176 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 7 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
42 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 7 Inmates Base Period: Date of award - 12 months
42 SS $________ $_________________
15BCTS21Q00000019 Page 6 of 71
Firm Fixed Price
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 5 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
5 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Intake - Mental Health (5005) (one per inmate) for Estimated 15 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 15 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 15 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 15 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
15 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 45 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
360 SS $________ $_________________
15BCTS21Q00000019 Page 7 of 71
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 21 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,008 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 21 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,008 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 10 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
240 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 21 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
504 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 21 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
126 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 21 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
105 SS $________ $_________________
15BCTS21Q00000019 Page 8 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Sex Offender-specific Evaluation and Report (5012) (one per inmate) for Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Intake Screening- Sex Offender (6005) (one per inmate) for Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
6 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
288 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
432 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Intake - Substance Use (2005) (one per inmate) for Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
30 EA $________ $_________________
15BCTS21Q00000019 Page 9 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
1,440 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
2,160 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
15BCTS21Q00000019 Page 10 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
840 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
840 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
30 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 5 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
5 SS $________ $_________________
15BCTS21Q00000019 Page 11 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Intake - Mental Health (5005) (one per inmate) for Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
15 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 30 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
240 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
720 SS $________ $_________________
15BCTS21Q00000019 Page 12 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
75 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Sex Offender-specific Evaluation and Report (5012) (one per inmate) for Estimated 6 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
6 EA $________ $_________________
15BCTS21Q00000019 Page 13 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Intake Screening- Sex Offender (6005) (one per inmate) for Estimated 6 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
6 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 6 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
288 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 6 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
432 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 6 Inmates Option Year 1- 13 months through 24 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Intake - Substance Use (2005) (one per inmate) for Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
15BCTS21Q00000019 Page 14 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
1,440 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
2,160 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
15BCTS21Q00000019 Page 15 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
840 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
840 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
30 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 5 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
5 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Intake - Mental Health (5005) (one per inmate) for Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
15 EA $________ $_________________
15BCTS21Q00000019 Page 16 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
15 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 30 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
240 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
720 EA $________ $_________________
15BCTS21Q00000019 Page 17 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
75 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Sex Offender-specific Evaluation and Report (5012) (one per inmate) for Estimated 6 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Intake Screening- Sex Offender (6005) (one per inmate) for Estimated 6 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
6 SS $________ $_________________
15BCTS21Q00000019 Page 18 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 6 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
288 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 6 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
432 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 6 Inmates Option Year 2- 25 months through 36 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Intake - Substance Use (2005) (one per inmate) for Estimated 30 Inmates Option Year 3- 37 months through 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
1,440 EA $________ $_________________
15BCTS21Q00000019 Page 19 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
2,160 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
840 SS $________ $_________________
15BCTS21Q00000019 Page 20 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
840 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
30 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 5 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
5 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Intake - Mental Health (5005) (one per inmate) for Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
15 SS $________ $_________________
15BCTS21Q00000019 Page 21 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 30 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
240 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
360 EA $________ $_________________
15BCTS21Q00000019 Page 22 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Sex Offender-specific Evaluation and Report (5012) (one per inmate) for Estimated 6 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
6 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Intake Screening- Sex Offender (6005) (one per inmate) for Estimated 6 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
6 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 6 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
288 SS $________ $_________________
15BCTS21Q00000019 Page 23 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 6 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
432 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 6 Inmates Option Year 3 - 37 months through 48 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Intake - Substance Use (2005) (one per inmate) for Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
1,440 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
2,160 SS $________ $_________________
15BCTS21Q00000019 Page 24 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
840 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
840 EA $________ $_________________
15BCTS21Q00000019 Page 25 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0127 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0128 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
30 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0129 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 5 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
5 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 Intake - Mental Health (5005) (one per inmate) for Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0132 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
15 EA $________ $_________________
15BCTS21Q00000019 Page 26 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0133 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
15 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0134 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 30 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
240 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0135 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
720 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0136 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0137 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
360 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0138 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
15BCTS21Q00000019 Page 27 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0139 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0140 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
75 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0141 Sex Offender-specific Evaluation and Report (5012) (one per inmate) for Estimated 6 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0142 Intake Screening- Sex Offender (6005) (one per inmate) for Estimated 6 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
6 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0143 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 6 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
288 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0144 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 6 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
432 EA $________ $_________________
15BCTS21Q00000019 Page 28 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0145 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 6 Inmates Option Year 4 - 49 months through 60 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0146 Intake - Substance Use (2005) (one per inmate) for Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0147 Assessment & Report - Substance Use (2011) (one per inmate) for Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0148 Individual Counseling - Substance Use (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0149 Group Counseling - Substance Use (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
1,080 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0150 Family Counseling - Substance Use (2030) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
15BCTS21Q00000019 Page 29 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0151 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
15 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0152 Buprenorphine Follow-Up and Report- MAT (4002) Estimated 6 Units per Inmate for Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0153 Naltrexone Follow-Up and Report- MAT (4003) Estimated 6 Units per Inmate for Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0154 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
504 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0155 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
504 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0156 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
18 EA $________ $_________________
15BCTS21Q00000019 Page 30 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0157 Naltrexone and Administration- MAT (4041) Estimated 6 Units per Inmate; Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
18 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0158 Psychiatric Evaluation & Report- MAT (4050) Estimated 1 Units per Inmate; Estimated 3 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
3 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0159 Intake - Mental Health (5005) (one per inmate) for Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0160 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
8 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0161 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
8 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0162 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
8 EA $________ $_________________
15BCTS21Q00000019 Page 31 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0163 Transportation, Round Trip (1202) Estimated 8 Units per Inmate; Estimated 15 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
120 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0164 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
384 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0165 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
384 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0166 Case Management Services (6030) Estimated 24 Units per Inmate; Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
192 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0167 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 24 Units per Inmate; Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
PSC: G004
192 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0168 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 8 Inmates Potential Six-Month Extension
Firm Fixed Price
48 EA $________ $_________________
15BCTS21Q00000019 Page 32 of 71
QUANTITY
UNIT UNIT PRICE AMOUNT
0169 Medication Monitoring - Mental Health (6051) (5 visits per inmate) for Estimated 8 Inmates Potential Six-Month Extension
Firm…
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