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15BCTS21Q00000037 Page 1 of 66
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30
1. REQUISITION NUMBER
5. SOLICITATION NUMBER
15BCTS21Q00000037
2. CONTRACT NO. 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
03/30/2021
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Paul Clark p5clark@bop.gov
b. TELEPHONE NUMBER (No collect calls)
202-353-0382
8. OFFER DUE DATE / LOCAL
TIME
04/14/2021 12:00 ET
CODE BCTS
Federal Bureau of Prisons Community Treatment Svcs Contractng 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:
SIZE STANDARD: $16,500,000
10. THE ACQUISITION IS
SEE
SCHEDULE
11. DELIVERY FOR FOB DESTINATION
UNLESS BLOCK IS MARKED
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
15B300CODE15. DELIVER TO
Federal Bureau of Prisons SouthEast Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Svcs Contractng 320 First Street NW Room 901-5 Washington, DC 20534
Paul Clark
(O) 202-353-0382 p5clark@bop.gov
FACILITY
CODE
CODE
TELEPHONE NO.
17a. CONTRACTOR/
OFFEROR
15B300CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons SouthEast Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
BOP-RSD/PSBCTS-BILL@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 NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
Outpatient Substance Use, Mental Health, Medication Assisted and Sex Offender Treatment Services for male and female offenders residing in the community of Spanish Fort, AL.
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)
Paul Clark
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
37 - 2021
7/01/2021
621420
15BCTS21Q00000037 Page 2 of 66
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
15BCTS21Q00000037 Page 3 of 66
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 (Oct 1995) 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) 52.203-17 Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights (Jun 2020)
4 List of Attachments 5 Solicitation Provisions
52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Dec 2019) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Dec 2019) 52.212-3 Offeror Representations and Certifications-Commercial Items (Feb 2021) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (Jan 1998) 52.216-1 Type of Contract (Apr 1984) 52.217-5 Evaluation of Options (July 1990)
15BCTS21Q00000037 Page 4 of 66
Section 2 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Substance Use Intake Screening (2005) (one per inmate) for Estimated 10 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 42 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
2,016 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Intake Assessment & Report (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
0004 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
0005 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 42 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
3,024 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS21Q00000037 Page 5 of 66
0006 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit 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
0008 Naltrexone Follow-Up and Report- MAT (4003) Estimated 2 Units per Inmate for Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Base Period: Date of award - 12 months
6 EA $________ $_________________
15BCTS21Q00000037 Page 6 of 66
Firm Fixed Price
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 2 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Naltrexone and Administration- MAT (4041) Estimated 2 Units per Inmate; Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Psychiatric Evaluation & Report- MAT (4050) Estimated 3 Units per Inmate; Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 10 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 18 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
15BCTS21Q00000037 Page 7 of 66
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 18 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Crisis Intervention - Mental Health (6000) (two per inmate) for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 26 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
1,248 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
9 EA $________ $_________________
15BCTS21Q00000037 Page 8 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 26 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
156 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Medication Monitoring and Report - Mental Health (6051) (5 visits per inmate) for Estimated 26 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
130 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Sex Offender Specific Intake Assessment & Report (5012) (two per inmate) for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Intake Screening- Sex Offender (6005) (two per inmate) for Estimated 1 Inmate Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 2 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
PSC: G004
96 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 2 Inmates Base Period: Date of award - 12 months
Firm Fixed Price
144 EA $________ $_________________
15BCTS21Q00000037 Page 9 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 2 Units per Inmate; Estimated 3 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
0032 Substance Use Intake Screening (2005) (one per inmate) for Estimated 10 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
1,440 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Substance Use Intake Assessment & Report (2011)(one per inmate) for Estimated 30 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
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 - 24 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
2,160 EA $________ $_________________
15BCTS21Q00000037 Page 10 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit per Inmate for Estimated 6 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Naltrexone Follow-Up and Report- MAT (4003) Estimated 2 Units per Inmate for Estimated 6 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
15BCTS21Q00000037 Page 11 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Naltrexone and Administration- MAT (4041) Estimated 2 Units per Inmate; Estimated 6 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Psychiatric Evaluation & Report- MAT (4050) Estimated 3 Units per Inmate; Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 10 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
10 EA $________ $_________________
15BCTS21Q00000037 Page 12 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Crisis Intervention - Mental Health (6000) (two per inmate) for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
18 EA $________ $_________________
15BCTS21Q00000037 Page 13 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
9 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
108 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Medication Monitoring and Report - Mental Health (6051) (5 visits per inmate) for Estimated 18 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 Sex Offender Specific Intake Assessment & Report (5012) (two per inmate) for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Intake Screening- Sex Offender (6005) (two per inmate) for Estimated 1 Inmate Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 2 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
96 EA $________ $_________________
15BCTS21Q00000037 Page 14 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 2 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 2 Units per Inmate; Estimated 3 Inmates Option Year 1: 13 - 24 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Substance Use Intake Screening (2005) (one per inmate) for Estimated 10 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
1,440 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Substance Use Intake Assessment & Report (2011)(one per inmate) for Estimated 30 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Dual Diagnosis Intake Assessment & Report (2012 )(one per inmate) for Estimated 30 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
30 EA $________ $_________________
15BCTS21Q00000037 Page 15 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
2,160 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit per Inmate for Estimated 6 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Naltrexone Follow-Up and Report- MAT (4003) Estimated 2 Units per Inmate for Estimated 6 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
168 EA $________ $_________________
15BCTS21Q00000037 Page 16 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Naltrexone and Administration- MAT (4041) Estimated 2 Units per Inmate; Estimated 6 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Psychiatric Evaluation & Report- MAT (4050) Estimated 3 Units per Inmate; Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
3 EA $________ $_________________
15BCTS21Q00000037 Page 17 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 10 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Crisis Intervention - Mental Health (6000) (two per inmate) for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
864 EA $________ $_________________
15BCTS21Q00000037 Page 18 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
9 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
108 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Medication Monitoring and Report - Mental Health (6051) (5 visits per inmate) for Estimated 18 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Sex Offender Specific Intake Assessment & Report (5012) (two per inmate) for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Intake Screening- Sex Offender (6005) (two per inmate) for Estimated 1 Inmate Option Year 2: 25 - 36 months
Firm Fixed Price
2 EA $________ $_________________
15BCTS21Q00000037 Page 19 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 2 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
96 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 2 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 2 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 - 36 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Substance Use Intake Screening (2005) (one per inmate) for Estimated 10 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
1,440 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Substance Use Intake Assessment & Report (2011)(one per inmate) for Estimated 30 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
30 EA $________ $_________________
15BCTS21Q00000037 Page 20 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Dual Diagnosis Intake Assessment & Report (2012 )(one per inmate) for Estimated 30 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
2,160 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit per Inmate for Estimated 6 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Naltrexone Follow-Up and Report- MAT (4003) Estimated 2 Units per Inmate for Estimated 6 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
168 EA $________ $_________________
15BCTS21Q00000037 Page 21 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Naltrexone and Administration- MAT (4041) Estimated 2 Units per Inmate; Estimated 6 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
12 EA $________ $_________________
15BCTS21Q00000037 Page 22 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Psychiatric Evaluation & Report- MAT (4050) Estimated 3 Units per Inmate; Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 10 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Crisis Intervention - Mental Health (6000) (two per inmate) for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
864 EA $________ $_________________
15BCTS21Q00000037 Page 23 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
9 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
108 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Medication Monitoring and Report - Mental Health (6051) (5 visits per inmate) for Estimated 18 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
90 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Sex Offender Specific Intake Assessment & Report (5012) (two per inmate) for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
15BCTS21Q00000037 Page 24 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 Intake Screening- Sex Offender (6005) (two per inmate) for Estimated 1 Inmate Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 2 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
96 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 2 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 2 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 - 48 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Substance Use Intake Screening (2005) (one per inmate) for Estimated 10 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 30 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
1,440 EA $________ $_________________
15BCTS21Q00000037 Page 25 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0127 Substance Use Intake Assessment & Report (2011)(one per inmate) for Estimated 30 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0128 Dual Diagnosis Intake Assessment & Report (2012 )(one per inmate) for Estimated 30 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0129 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 30 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
2,160 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit per Inmate for Estimated 6 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0132 Naltrexone Follow-Up and Report- MAT (4003) Estimated 2 Units per Inmate for Estimated 6 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
15BCTS21Q00000037 Page 26 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0133 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0134 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0135 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0136 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0137 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0138 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
15BCTS21Q00000037 Page 27 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0139 Naltrexone and Administration- MAT (4041) Estimated 2 Units per Inmate; Estimated 6 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0140 Psychiatric Evaluation & Report- MAT (4050) Estimated 3 Units per Inmate; Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0141 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 10 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0142 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0143 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0144 Crisis Intervention - Mental Health (6000) (two per inmate) for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
15BCTS21Q00000037 Page 28 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0145 Individual Counseling - Mental Health (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0146 Group Counseling - Mental Health (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
864 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0147 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0148 Family Counseling - Mental Health (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
9 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0149 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
108 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0150 Medication Monitoring and Report - Mental Health (6051) (5 visits per inmate) for Estimated 18 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
90 EA $________ $_________________
15BCTS21Q00000037 Page 29 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0151 Sex Offender Specific Intake Assessment & Report (5012) (two per inmate) for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0152 Intake Screening- Sex Offender (6005) (two per inmate) for Estimated 1 Inmate Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0153 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 2 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
96 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0154 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 2 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
144 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0155 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 2 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 - 60 months
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0156 Substance Use Intake Screening (2005) (one per inmate) for Estimated 5 Inmates Six Month Extension
Firm Fixed Price
5 EA $________ $_________________
15BCTS21Q00000037 Page 30 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0157 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
720 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0158 Substance Use Intake Assessment & Report (2011)(one per inmate) for Estimated 15 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0159 Dual Diagnosis Intake Assessment & Report (2012 )(one per inmate) for Estimated 15 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
15 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0160 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 15 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
1,080 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0161 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 2 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0162 Buprenorphine Follow-Up and Report- MAT (4002)Estimated 1 Unit per Inmate for Estimated 6 Inmates Six Month Extension
Firm Fixed Price
15BCTS21Q00000037 Page 31 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0163 Naltrexone Follow-Up and Report- MAT (4003) Estimated 1 Units per Inmate for Estimated 6 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0164 Administration of Buprenorphine - MAT (4020) Estimated 168 Units per Inmate for Estimated 1 Inmate Six Month Extension
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0165 Buprenorphine and Administration - MAT (4021) Estimated 168 Units per Inmate for Estimated 1 Inmate Six Month Extension
Firm Fixed Price
PSC: G004
168 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0166 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 1 Inmate Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0167 Buprenorphine and Administration of Injection MAT (4031) Estimated 6 Units per Inmate for Estimated 1 Inmate Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0168 Buprenorphine Implant and Removal MAT (4032) Estimated 1 Unit per Inmate for Estimated 1 Inmate Six Month Extension
Firm Fixed Price
1 EA $________ $_________________
15BCTS21Q00000037 Page 32 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0169 Administration of Naltrexone- MAT (4040) Estimated 6 Units per Inmate for Estimated 1 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0170 Naltrexone and Administration- MAT (4041) Estimated 1 Units per Inmate; Estimated 6 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0171 Psychiatric Evaluation & Report- MAT (4050) Estimated 2 Units per Inmate; Estimated 1 Inmate Six Month Extension
Firm Fixed Price
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0172 Mental Health Intake Screening (5005) Estimated 1 Unit per Inmate; Estimated 5 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0173 Assessment & Report - Mental Health (5011) (one per inmate) for Estimated 9 Inmates Six Month Extension
Firm Fixed Price
PSC: G004
9 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0174 Psychiatric Evaluation & Report - Mental Health (5030) (one per inmate) for Estimated 9 Inmates Six Month Extension
Firm Fixed Price
9 EA $________ $_________________
15BCTS21Q00000037 Page 33 of 66
QUANTITY
UNIT UNIT PRICE AMOUNT
0175 Crisis Intervention - Mental Health (6000) (one per inmate) for Estimated 1 Inmate Six Month…
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