15BCTS23Q00000001.pdf
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- Solicitation number
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15BCTS23Q00000001 Page 1 of 68
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30
1. REQUISITION NUMBER PAGE 1 OF
5. SOLICITATION NUMBER
15BCTS23Q00000001
2. CONTRACT NO. 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
03/17/2023
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
04/21/2023 12:00 ET
CODE BCTS
Federal Bureau of Prisons Acquisitions Branch/Community Treatment Svcs Contractng 320 First Street NW Room 901-5 Washington, DC 20534
9. ISSUED BY UNRESTRICTED OR X SET ASIDE:100.00 % FOR
X SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS: 621420
SIZE STANDARD: $19,000,000
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
15B400CODE15. DELIVER TO
Federal Bureau of Prisons North Central Regional Office
400 STATE AVENUE
SUITE 800
Kansas City, KS 66101
CODE BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Acquisitions Branch/Community Treatment Svcs Contractng 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
15B400CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons North Central Regional Office
400 STATE AVENUE
SUITE 800
Kansas City, KS 66101
BOP-RSD-CRBCTS-BILL-KC@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
Substance Use, Mental Health, Medication Assisted Treatment and Sex Offender Treatment Services in Kearney, NE.
Firm Fixed Price
See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For 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 ARE X ARE NOT ATTACHED
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED
X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO
ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH
OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE
TERMS AND CONDITIONS SPECIFIED.
29. AWARD OF CONTRACT: 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)
Shuwona Jones
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
RCA 001-23
15BCTS23Q00000001 Page 2 of 68
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
15BCTS23Q00000001 Page 3 of 68
Table of Contents
Section Description Page Number
1 Solicitation/Contract Form 2 Commodity or Services Schedule 3 Contract Clauses
52.242-15 Stop-Work Order (Aug 1989) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) DOJ-05 Security of Department Information and Systems (APR 2015) 52.203-3 Gratuities (Apr 1984) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Nov 2021) 52.253-1 Computer Generated Forms (Jan 1991) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.223-99 DEV Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors (Oct 2021)
(DEVIATION)
52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR
2011) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-01 Whistleblower Information Distribution (Oct 2021) 52.242-13 Bankruptcy (July 1995) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Dec 2022) 52.216-22 Indefinite Quantity (Oct 1995) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency
(OCT 2007)
4 List of Attachments 5 Solicitation Provisions
52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Dec 2022) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.216-1 Type of Contract (Apr 1984)
15BCTS23Q00000001 Page 4 of 68
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)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Individual Counseling (2010)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 800
PSC: G004
40 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Intake Assessment & Report (2011)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40
PSC: G004
10 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Dual Diagnosis Intake Assessment & Report (2012)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Substance Use Group Counseling (2020)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
PSC: G004
120 EA $________ $_________________
15BCTS23Q00000001 Page 5 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Family Counseling (2030)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 MAT- Buprenorphine Follow-Up and Report (4002)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 80
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 MAT - Naltrexone Follow-Up and Report (4003)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 MAT - Psychiatric Evaluation & Report (4050)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Intake Screening- Mental Health (5005)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Intake Assessment & Report- Mental Health (5011)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
2 EA $________ $_________________
15BCTS23Q00000001 Page 6 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Psychiatric Evaluation & Report- Mental Health (5030)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Crisis Intervention Evaluation & Report (6000)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Individual Counseling- Mental Health (6010)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Family Counseling- Mental Health (6031)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Medication Monitoring and Report- Mental Health (6051)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 Specific Intake Assessment & Report- Sex Offender (5012)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 1
1 EA $________ $_________________
15BCTS23Q00000001 Page 7 of 68
Estimated Maximum Quantity: 10
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Intake Screening- Sex Offender (6005)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Individual Counseling - Sex Offender (6012)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Group Counseling - Sex Offender (6022)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Family Counseling - Sex Offender (6032)
Base Period: Date of award - 12 months
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Intake Screening (2005)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Substance Use Individual Counseling (2010)
Option Year 1: 13 months through 24
40 SS $________ $_________________
15BCTS23Q00000001 Page 8 of 68
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 800
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Substance Use Intake Assessment & Report (2011)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40
PSC: G004
10 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Dual Diagnosis Intake Assessment & Report (2012)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Substance Use Group Counseling (2020)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Family Counseling (2030)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 MAT- Buprenorphine Follow-Up and Report (4002)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 80
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS23Q00000001 Page 9 of 68
0029 MAT - Naltrexone Follow-Up and Report (4003)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 MAT - Psychiatric Evaluation & Report (4050)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Intake Screening- Mental Health (5005)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Intake Assessment & Report- Mental Health (5011)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Psychiatric Evaluation & Report- Mental Health (5030)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Crisis Intervention Evaluation & Report (6000)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
15BCTS23Q00000001 Page 10 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Individual Counseling- Mental Health (6010)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Family Counseling- Mental Health (6031)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Medication Monitoring and Report- Mental Health (6051)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Specific Intake Assessment & Report- Sex Offender (5012)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Intake Screening- Sex Offender (6005)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Individual Counseling - Sex Offender (6012)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
15BCTS23Q00000001 Page 11 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Group Counseling - Sex Offender (6022)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Family Counseling - Sex Offender (6032)
Option Year 1: 13 months through 24
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Substance Use Intake Screening (2005)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Substance Use Individual Counseling (2010)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 800
PSC: G004
40 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Substance Use Intake Assessment & Report (2011)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40
PSC: G004
10 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Dual Diagnosis Intake Assessment & Report (2012)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2
2 SS $________ $_________________
15BCTS23Q00000001 Page 12 of 68
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Substance Use Group Counseling (2020)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Substance Use Family Counseling (2030)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 MAT- Buprenorphine Follow-Up and Report (4002)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 80
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 MAT - Naltrexone Follow-Up and Report (4003)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 MAT - Psychiatric Evaluation & Report (4050)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Intake Screening- Mental Health (5005)
Option Year 2: 25 months through 36
15BCTS23Q00000001 Page 13 of 68
Estimated Maximum Quantity: 20
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Intake Assessment & Report- Mental Health (5011)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Psychiatric Evaluation & Report- Mental Health (5030)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Crisis Intervention Evaluation & Report (6000)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Individual Counseling- Mental Health (6010)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Family Counseling- Mental Health (6031)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000001 Page 14 of 68
0058 Medication Monitoring and Report- Mental Health (6051)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Specific Intake Assessment & Report- Sex Offender (5012)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Intake Screening- Sex Offender (6005)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Individual Counseling - Sex Offender (6012)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Group Counseling - Sex Offender (6022)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Family Counseling - Sex Offender (6032)
Option Year 2: 25 months through 36
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
15BCTS23Q00000001 Page 15 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Intake Screening - Substance Use (2005)
Option Year 3: 37monthhs through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Individual Counseling - Substance Use (2010)
Option Year 3: 37monthhs through 48
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 800
PSC: G004
40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Intake Assessment & Report - Substance Use (2011)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Intake Assessment & Report - Dual Diagnosis (2012)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Group Counseling - Substance Use (2020)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Family Counseling - Substance Use (2030)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
15BCTS23Q00000001 Page 16 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Buprenorphine Follow-Up and Report - MAT (4002)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 80
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Naltrexone Follow-Up and Report - MAT (4003)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Psychiatric Evaluation & Report - MAT (4050)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Intake Screening - Mental Health (5005)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Intake Assessment & Report - Mental Health (5011)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Psychiatric Evaluation & Report - Mental Health (5030)
Option Year 3: 37months through 48
15BCTS23Q00000001 Page 17 of 68
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Crisis Intervention Evaluation & Report (6000)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Individual Counseling - Mental Health (6010)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Family Counseling - Mental Health (6031)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Medication Monitoring and Report - Mental Health (6051)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Specific Intake Assessment & Report - Sex Offender (5012)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Intake Screening - Sex Offender (6005)
Option Year 3: 37months through 48
1 SS $________ $_________________
15BCTS23Q00000001 Page 18 of 68
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Individual Counseling - Sex Offender (6012)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Group Counseling - Sex Offender (6022)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Family Counseling - Sex Offender (6032)
Option Year 3: 37months through 48
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Intake Screening - Substance Use (2005)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Substance Use Individual Counseling (2010)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 800
PSC: G004
40 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000001 Page 19 of 68
0087 Substance Use Intake Assessment & Report (2011)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40
PSC: G004
10 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Dual Diagnosis Intake Assessment & Report (2012)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Substance Use Group Counseling (2020)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Substance Use Family Counseling (2030)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 MAT- Buprenorphine Follow-Up and Report (4002)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 80
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 MAT - Naltrexone Follow-Up and Report (4003)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
15BCTS23Q00000001 Page 20 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 MAT - Psychiatric Evaluation & Report (4050)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Intake Screening- Mental Health (5005)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 20
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Intake Assessment & Report- Mental Health (5011)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Psychiatric Evaluation & Report- Mental Health (5030)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Crisis Intervention Evaluation & Report (6000)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Individual Counseling- Mental Health (6010)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
32 EA $________ $_________________
15BCTS23Q00000001 Page 21 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Family Counseling- Mental Health (6031)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Medication Monitoring and Report- Mental Health (6051)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Specific Intake Assessment & Report- Sex Offender (5012)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Intake Screening- Sex Offender (6005)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Individual Counseling - Sex Offender (6012)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 240
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Group Counseling - Sex Offender (6022)
Option Year 4: 49months through 60
15BCTS23Q00000001 Page 22 of 68
Estimated Maximum Quantity: 240
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Family Counseling - Sex Offender (6032)
Option Year 4: 49months through 60
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Intake Screening - Substance Use (2005)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Individual Counseling - Substance Use (2010)
Potential Six Month Extension
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Intake Assessment & Report - Substance Use (2011)
Potential Six Month Extension
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 20
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Intake Assessment & Report - Dual Diagnosis (2012)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Group Counseling - Substance Use (2020)
Potential Six Month Extension
60 EA $________ $_________________
15BCTS23Q00000001 Page 23 of 68
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Family Counseling - Substance Use (2030)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Buprenorphine Follow-Up and Report - MAT (4002)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Naltrexone Follow-Up and Report - MAT (4003)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Psychiatric Evaluation & Report - MAT (4050)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Intake Screening - Mental Health (5005)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000001 Page 24 of 68
0116 Intake Assessment & Report - Mental Health (5011)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Psychiatric Evaluation & Report- Mental Health (5030)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Crisis Intervention Evaluation & Report (6000)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Individual Counseling - Mental Health (6010)
Potential Six Month Extension
Guaranteed Minimum Quantity: 16 Estimated Maximum Quantity: 400
PSC: G004
16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Family Counseling - Mental Health (6031)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 Medication Monitoring and Report - Mental Health (6051)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
15BCTS23Q00000001 Page 25 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 Specific Intake Assessment & Report - Sex Offender (5012)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Intake Screening - Sex Offender (6005)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
PSC: G004
1 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Individual Counseling - Sex Offender (6012)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 120
PSC: G004
1 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Group Counseling - Sex Offender (6022)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 120
PSC: G004
1 SS $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Family Counseling - Sex Offender (6032)
Potential Six Month Extension
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
15BCTS23Q00000001 Page 26 of 68
Section 3 - Contract Clauses
A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022)
The terms and conditions for the following clauses are hereby incorporated into this solicitation and resulting contract as an addendum to FAR clause 52.212-4.
Clauses By Reference
52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)
This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.acquisition.gov
Clause Title Fill-ins (if applicable)
52.242-15 Stop-Work Order (Aug 1989)
52.203-3 Gratuities (Apr 1984)
52.232-40 Providing Accelerated Payments to Small Business Subcontractors
(Nov 2021)
52.253-1 Computer Generated Forms (Jan 1991)
52.204-12 Unique Entity Identifier Maintenance (Oct 2016)
52.204-13 System for Award Management Maintenance (Oct 2018)
52.203-12 Limitation On Payments to Influence Certain Federal Transactions
(Jun 2020)
52.224-1 Privacy Act Notification (Apr 1984)
52.224-2 Privacy Act (Apr 1984)
52.212-4 Contract Terms and Conditions-Commercial Products and Commercial
Services (Dec 2022)
Clauses By Full Text
52.21-603-70 Contracting Officer's Representative (COR) (June 2012)
15BCTS23Q00000001 Page 27 of 68
(a)Melissa Acevedo (SCTC) ; Stephanie Hamilton (CTC); Michelle Blake (CTOS); Rick Dooley (CTOS); Tesia Easley (CTOS);
,Lindsey Martin (CTOS); Lashanda Williams (CTOS); Misty Hoffer (CTOS); and , Caitlin Wilbanks (MA),Kansas City Field Office, is hereby designated as the Contracting Officer's Representative (COR) under this contract.
(b) The COR is responsible, as applicable, for: receiving all deliverables, inspecting and accepting the supplies or services provide hereunder in accordance with the terms and conditions of this contract; providing direction to the contractor which clarifies the contractor effort, fills in details or otherwise serves to accomplish the contractual Scope of Work; evaluating performance; and certifying all invoices/vouchers for acceptance of the supplies or services furnished for payment.
(c) The COR does not have the authority to alter the contractor's obligations under the contract, and/or modify any of the expressed terms, conditions, specifications, or cost of the agreement. If as a result of technical discussions it is desirable to alter/change contractual obligations or the Scope of Work, the Contracting Officer shall issue such changes.
DOJ-05 Security of Department Information and Systems (APR 2015)
I. Applicability to Contractors and Subcontractors
This clause applies to all contractors and subcontractors, including cloud service providers (“CSPs”), and personnel of contractors, subcontractors, and CSPs (hereinafter collectively, “Contractor”) that may access, collect, store, process, maintain, use, share, retrieve, disseminate, transmit, or dispose of DOJ Information. It establishes and implements specific DOJ requirements applicable to this Contract. The requirements established herein are in addition to those required by the Federal Acquisition Regulation (“FAR”), including FAR 11.002(g) and 52.239-1, the Privacy Act of 1974, and any other applicable laws, mandates, Procurement Guidance Documents, and Executive Orders pertaining to the development and operation of Information Systems and the protection of Government Information. This clause does not alter or diminish any existing rights, obligation or liability under any other civil and/or criminal law, rule, regulation or mandate.
II. General Definitions
The following general definitions apply to this clause. Specific definitions also apply as set forth in other paragraphs.
A. Information means any communication or representation of knowledge such as facts, data, or opinions, in any form or medium, including textual, numerical, graphic, cartographic, narrative, or audiovisual. Information includes information in an electronic format that allows it be stored, retrieved or transmitted, also referred to as “data,” and “personally identifiable information” (“PII”), regardless of form.
B. Personally Identifiable Information (or PII) means any information about an individual maintained by an agency, including, but not limited to, information related to education, financial transactions, medical history, and criminal or employment history and information, which can be used to distinguish or trace an individual's identity, such as his or her name, social security number, date and place of birth, mother's maiden name, biometric records, etc., including any other personal information which is linked or linkable to an individual.
C. DOJ Information means any Information that is owned, produced, controlled, protected by, or otherwise within the custody or responsibility of the DOJ, including, without limitation, Information related to DOJ programs or personnel. It includes, without limitation, Information (1) provided by or generated for the DOJ, (2) managed or acquired by Contractor for the DOJ in connection with the performance of the contract, and/or (3) acquired in order to perform the contract.
D. Information System means any resources, or set of resources organized for accessing, collecting, storing, processing, maintaining, using, sharing, retrieving, disseminating, transmitting, or disposing of (hereinafter collectively, “processing, storing, or transmitting”) Information.
E. Covered Information System means any information system used for, involved with, or allowing, the processing, storing, or transmitting of DOJ Information.
III. Confidentiality and Non-disclosure of DOJ Information
A. Preliminary and final deliverables and all associated working papers and material generated by Contractor containing DOJ Information are the property of the U.S. Government and must be submitted to the Contracting Officer (“CO”) or the CO’s
15BCTS23Q00000001 Page 28 of 68
Representative (“COR”) at the conclusion of the contract. The U.S. Government has unlimited data rights to all such deliverables and associated working papers and materials in accordance with FAR 52.227-14.
B. All documents produced in the performance of this contract containing DOJ Information are the property of the U.S.
Government and Contractor shall neither reproduce nor release to any third-party at any time, including during or at expiration or termination of the contract without the prior written permission of the CO.
C. Any DOJ information made available to Contractor under this contract shall be used only for the purpose of performance of this contract and shall not be divulged or made known in any manner to any persons except as may be necessary in the performance of this contract. In performance of this contract, Contractor assumes responsibility for the protection of the confidentiality of any and all DOJ Information processed, stored, or transmitted by the Contractor. When requested by the CO (typically no more than annually), Contractor shall provide a report to the CO identifying, to the best of Contractor’s knowledge and belief, the type, amount, and level of sensitivity of the DOJ Information processed, stored, or transmitted under the Contract, including an estimate of the number of individuals for whom PII has been processed, stored or transmitted under the Contract and whether such information includes social security numbers (in whole or in part).
IV. Compliance with Information Technology Security Policies, Procedures and Requirements
A. For all Covered Information Systems, Contractor shall comply with all security requirements, including but not limited to the regulations and guidance found in the Federal Information Security Management Act of 2014 (“FISMA”), Privacy Act of 1974, E-Government Act of 2002, National Institute of Standards and Technology (“NIST”) Special Publications (“SP”), including NIST SP 800-37, 800-53, and 800-60 Volumes I and II, Federal Information Processing Standards (“FIPS”) Publications 140-2, 199, and 200, OMB Memoranda, Federal Risk and Authorization Management Program (“FedRAMP”), DOJ IT Security Standards, including DOJ Order 2640.2, as amended. These requirements include but are not limited to:
1. Limiting access to DOJ Information and Covered Information Systems to authorized users and to transactions and functions that authorized users are permitted to exercise;
2. Providing security awareness training including, but not limited to, recognizing and reporting potential indicators of insider threats to users and managers of DOJ Information and Covered Information Systems;
3. Creating, protecting, and retaining Covered Information System audit records, reports, and supporting documentation to enable reviewing, monitoring, analysis, investigation, reconstruction, and reporting of unlawful, unauthorized, or inappropriate activity related to such Covered Information Systems and/or DOJ Information;
4. Maintaining authorizations to operate any Covered Information System;
5. Performing continuous monitoring on all Covered Information Systems;
6. Establishing and maintaining baseline configurations and inventories of Covered Information Systems, including hardware, software, firmware, and documentation, throughout the Information System Development Lifecycle, and establishing and enforcing security configuration settings for IT products employed in Information Systems;
7. Ensuring appropriate contingency planning has been performed, including DOJ Information and Covered Information System backups;
8. Identifying Covered Information System users, processes acting on behalf of users, or devices, and authenticating and verifying the identities of such users, processes, or devices, using multifactor authentication or HSPD-12 compliant authentication methods where required;
9. Establishing an operational incident handling capability for Covered Information Systems that includes adequate preparation, detection, analysis, containment, recovery, and user response activities, and tracking, documenting, and reporting incidents to appropriate officials and authorities within Contractor’s organization and the DOJ;
10. Performing periodic and timely maintenance on Covered Information Systems, and providing effective controls on tools, techniques, mechanisms, and personnel used to conduct such maintenance;
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12. Protecting Covered Information System media containing DOJ Information, including paper, digital and electronic media; limiting access to DOJ Information to authorized users; and sanitizing or destroying Covered Information System media containing DOJ Information before disposal, release or reuse of such media;
13. Limiting physical access to Covered Information Systems, equipment, and physical facilities housing such Covered Information Systems to authorized U.S. citizens unless a waiver has been granted by the Contracting Officer (“CO”), and protecting the physical facilities and support infrastructure for such Information Systems;
14. Screening individuals prior to authorizing access to Covered Information Systems to ensure compliance with DOJ Security standards;
15. Assessing the risk to DOJ Information in Covered Information Systems periodically, including scanning for vulnerabilities and remediating such vulnerabilities in accordance with DOJ policy and ensuring the timely removal of assets no longer supported by the Contractor;
16. Assessing the security controls of Covered Information Systems periodically to determine if the controls are effective in their application, developing and implementing plans of action designed to correct deficiencies and eliminate or reduce vulnerabilities in such Information Systems, and monitoring security controls on an ongoing basis to ensure the continued effectiveness of the controls;
17. Monitoring, controlling, and protecting information…
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