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15BCTS23Q00000004 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
15BCTS23Q00000004
2. CONTRACT NO. 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
05/18/2022
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
06/17/2022 14:00 ET
CODE 15BCTS
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS: 621420
SIZE STANDARD: $16,500,000
10. THE ACQUISITION IS
SEE
SCHEDULE
11. DELIVERY FOR FOB DESTINATION
UNLESS BLOCK IS MARKED
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
BWROCODE15. DELIVER TO
Federal Bureau of Prisons Western Region - TDAT Office TDAT Office 1299 Seaside Avenue San Pedro, CA 90731
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Paul Clark
(O) 202-353-0382 p5clark@bop.gov
FACILITY
CODE
CODE
TELEPHONE NO.
17a. CONTRACTOR/
OFFEROR
BWROCODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons Western Region - TDAT Office TDAT Office 1299 Seaside Avenue San Pedro, CA 90731
BOP-RSD-CRBCTS-BILL-LA@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, Sex Offender and Medication Assisted Treatment Services in Tucson, AZ.
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)
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
004 - 23
15BCTS23Q00000004 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
15BCTS23Q00000004 Page 3 of 68
Table of Contents
Section Description Page Number
1 Solicitation/Contract Form 2 Commodity or Services Schedule 3 Contract Clauses
52.21-603-70 Contracting Officer's Representative (COR) (June 2012)
52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE
2004)
52.218-000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA
OR OTHER NATIONAL EMERGENCY (May 2008) DJAR-PGD-15-03 Security of Department Information and Systems 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-21 Requirements (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR
2011) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Nov 2021) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Jan 2022) 52.203-17 Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights (Jun 2020) DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021); (Alt. I) -- Classified Information -- Cleared Contractors
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 (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 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)
15BCTS23Q00000004 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 2005 Substance Use Intake Screening - 2 Units Guaranteed Minimum; 15 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 2010 Substance Use Individual Counseling - 300 Units Guaranteed Minimum; 2200 Units Estimated Maximum.
Base Period: Date of award - 12 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 2011 Substance Use Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 2012 Dual Diagnosis Intake Assessment and Report - 10 Units Guaranteed Minimum; 25 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 2020 Substance Use Group Counseling - 480 Units Guaranteed Minimum; 1800 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
480 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 2030 Substance Use Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS23Q00000004 Page 5 of 68
0007 4002 MAT – Buprenorphine Follow-up and Report - 6 Units Guaranteed Minimum; 60 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 4003 MAT – Naltrexone Follow-up and Report - 3 Units Guaranteed Minimum; 20 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 4050 MAT – Psychiatric Evaluation and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 5005 Mental Health Intake Screening - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 5011 Mental Health Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 5030 Psychiatric Evaluation & Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 6010 Mental Health Individual Counseling - 300 Units Guaranteed Minimum; 2000 Units Estimated Maximum Base Period: Date of award - 12 months
300 EA $________ $_________________
15BCTS23Q00000004 Page 6 of 68
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 6020 Mental Health Group Counseling - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 6030 Case Management Services - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 6031 Mental Health Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 6050 Administration of Medication - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 6051 Mental Health Medication Monitoring - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 5012 Sex Offender Intake Assessment and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Base Period: Date of award - 12 months
1 EA $________ $_________________
15BCTS23Q00000004 Page 7 of 68
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 6012 Sex Offender Individual Counseling - 32 Units Guaranteed Minimum; 240 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 6022 Sex Offender Group Counseling - 24 Units Guaranteed Minimum; 360 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 6032 Sex Offender Family Counseling - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Base Period: Date of award - 12 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 2005 Substance Use Intake Screening - 2 Units Guaranteed Minimum; 15 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 2010 Substance Use Individual Counseling - 300 Units Guaranteed Minimum; 2200 Units Estimated Maximum.
Option Year 1: 13 - 24 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 2011 Substance Use Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 2012 Dual Diagnosis Intake Assessment and Report - 10 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 1: 13 - 24 months
10 EA $________ $_________________
15BCTS23Q00000004 Page 8 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 2020 Substance Use Group Counseling - 480 Units Guaranteed Minimum; 1800 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
480 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 2030 Substance Use Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 4002 MAT – Buprenorphine Follow-up and Report - 6 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 4003 MAT – Naltrexone Follow-up and Report - 3 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 4050 MAT – Psychiatric Evaluation and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 5005 Mental Health Intake Screening - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 5011 Mental Health Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 1: 13 - 24 months
15BCTS23Q00000004 Page 9 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 5030 Psychiatric Evaluation & Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 6010 Mental Health Individual Counseling - 300 Units Guaranteed Minimum; 2000 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 6020 Mental Health Group Counseling - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 6030 Case Management Services - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 6031 Mental Health Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 6050 Administration of Medication - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 1: 13 - 24 months
15BCTS23Q00000004 Page 10 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 6051 Mental Health Medication Monitoring - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 5012 Sex Offender Intake Assessment and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 6012 Sex Offender Individual Counseling - 32 Units Guaranteed Minimum; 240 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 6022 Sex Offender Group Counseling - 24 Units Guaranteed Minimum; 360 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 6032 Sex Offender Family Counseling - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 1: 13 - 24 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 2005 Substance Use Intake Screening - 2 Units Guaranteed Minimum; 15 Units Estimated Maximum Option Year 2: 25 - 36 months
2 EA $________ $_________________
15BCTS23Q00000004 Page 11 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 2010 Substance Use Individual Counseling - 300 Units Guaranteed Minimum; 2200 Units Estimated Maximum.
Option Year 2: 25 - 36 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 2011 Substance Use Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 2012 Dual Diagnosis Intake Assessment and Report - 10 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 2020 Substance Use Group Counseling - 480 Units Guaranteed Minimum; 1800 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
480 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 2030 Substance Use Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 4002 MAT – Buprenorphine Follow-up and Report - 6 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 4003 MAT – Naltrexone Follow-up and Report - 3 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 2: 25 - 36 months
3 EA $________ $_________________
15BCTS23Q00000004 Page 12 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 4050 MAT – Psychiatric Evaluation and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 5005 Mental Health Intake Screening - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 5011 Mental Health Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 5030 Psychiatric Evaluation & Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 6010 Mental Health Individual Counseling - 300 Units Guaranteed Minimum; 2000 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 6020 Mental Health Group Counseling - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 2: 25 - 36 months
20 EA $________ $_________________
15BCTS23Q00000004 Page 13 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 6030 Case Management Services - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 6031 Mental Health Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 6050 Administration of Medication - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 6051 Mental Health Medication Monitoring - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 5012 Sex Offender Intake Assessment and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 6012 Sex Offender Individual Counseling - 32 Units Guaranteed Minimum; 240 Units Estimated Maximum Option Year 2: 25 - 36 months
32 EA $________ $_________________
15BCTS23Q00000004 Page 14 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 6022 Sex Offender Group Counseling - 24 Units Guaranteed Minimum; 360 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 6032 Sex Offender Family Counseling - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 2: 25 - 36 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 2005 Substance Use Intake Screening - 2 Units Guaranteed Minimum; 15 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 2010 Substance Use Individual Counseling - 300 Units Guaranteed Minimum; 2200 Units Estimated Maximum.
Option Year 3: 37 - 48 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 2011 Substance Use Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 2012 Dual Diagnosis Intake Assessment and Report - 10 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 2020 Substance Use Group Counseling - 480 Units Guaranteed Minimum; 1800 Units Estimated Maximum Option Year 3: 37 - 48 months
480 EA $________ $_________________
15BCTS23Q00000004 Page 15 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 2030 Substance Use Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 4002 MAT – Buprenorphine Follow-up and Report - 6 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 4003 MAT – Naltrexone Follow-up and Report - 3 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 4050 MAT – Psychiatric Evaluation and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 5005 Mental Health Intake Screening - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 5011 Mental Health Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 5030 Psychiatric Evaluation & Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 3: 37 - 48 months
15BCTS23Q00000004 Page 16 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 6010 Mental Health Individual Counseling - 300 Units Guaranteed Minimum; 2000 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 6020 Mental Health Group Counseling - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 6030 Case Management Services - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 6031 Mental Health Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 6050 Administration of Medication - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 6051 Mental Health Medication Monitoring - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 3: 37 - 48 months
20 EA $________ $_________________
15BCTS23Q00000004 Page 17 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 5012 Sex Offender Intake Assessment and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 6012 Sex Offender Individual Counseling - 32 Units Guaranteed Minimum; 240 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 6022 Sex Offender Group Counseling - 24 Units Guaranteed Minimum; 360 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 6032 Sex Offender Family Counseling - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 3: 37 - 48 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 2005 Substance Use Intake Screening - 2 Units Guaranteed Minimum; 15 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 2010 Substance Use Individual Counseling - 300 Units Guaranteed Minimum; 2200 Units Estimated Maximum.
Option Year 4: 49 - 60 months
300 EA $________ $_________________
15BCTS23Q00000004 Page 18 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 2011 Substance Use Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 2012 Dual Diagnosis Intake Assessment and Report - 10 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 2020 Substance Use Group Counseling - 480 Units Guaranteed Minimum; 1800 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
480 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 2030 Substance Use Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 4002 MAT – Buprenorphine Follow-up and Report - 6 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 4003 MAT – Naltrexone Follow-up and Report - 3 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 4050 MAT – Psychiatric Evaluation and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 4: 49 - 60 months
2 EA $________ $_________________
15BCTS23Q00000004 Page 19 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 5005 Mental Health Intake Screening - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 5011 Mental Health Intake Assessment and Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 5030 Psychiatric Evaluation & Report - 10 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 6010 Mental Health Individual Counseling - 300 Units Guaranteed Minimum; 2000 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 6020 Mental Health Group Counseling - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 6030 Case Management Services - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Option Year 4: 49 - 60 months
15BCTS23Q00000004 Page 20 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 6031 Mental Health Family Counseling - 2 Units Guaranteed Minimum; 20 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 6050 Administration of Medication - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 6051 Mental Health Medication Monitoring - 20 Units Guaranteed Minimum; 60 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 5012 Sex Offender Intake Assessment and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
10 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 6012 Sex Offender Individual Counseling - 32 Units Guaranteed Minimum; 240 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
32 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 6022 Sex Offender Group Counseling - 24 Units Guaranteed Minimum; 360 Units Estimated Maximum Option Year 4: 49 - 60 months
24 EA $________ $_________________
15BCTS23Q00000004 Page 21 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 6032 Sex Offender Family Counseling - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Option Year 4: 49 - 60 months
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 2005 Substance Use Intake Screening - 1 Unit Guaranteed Minimum; 8 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 2010 Substance Use Individual Counseling - 150 Units Guaranteed Minimum; 1100 Units Estimated Maximum.
Potential Six Month Extension
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 2011 Substance Use Intake Assessment and Report - 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Potential Six Month Extension
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 2012 Dual Diagnosis Intake Assessment and Report - 5 Units Guaranteed Minimum; 13 Units Estimated Maximum Potential Six Month Extension
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 2020 Substance Use Group Counseling - 240 Units Guaranteed Minimum; 900 Units Estimated Maximum Potential Six Month Extension
PSC: G004
240 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 2030 Substance Use Family Counseling - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Potential Six Month Extension
15BCTS23Q00000004 Page 22 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0127 4002 MAT – Buprenorphine Follow-up and Report - 3 Units Guaranteed Minimum; 30 Units Estimated Maximum Potential Six Month Extension
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0128 4003 MAT – Naltrexone Follow-up and Report - 2 Units Guaranteed Minimum; 10 Units Estimated Maximum Potential Six Month Extension
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0129 4050 MAT – Psychiatric Evaluation and Report - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 5005 Mental Health Intake Screening - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 5011 Mental Health Intake Assessment and Report - 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Potential Six Month Extension
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0132 5030 Psychiatric Evaluation & Report - 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Potential Six Month Extension
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0133 6000 Crisis Intervention - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Potential Six Month Extension
15BCTS23Q00000004 Page 23 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0134 6010 Mental Health Individual Counseling - 150 Units Guaranteed Minimum; 1000 Units Estimated Maximum Potential Six Month Extension
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0135 6020 Mental Health Group Counseling - 10 Units Guaranteed Minimum; 30 Units Estimated Maximum Potential Six Month Extension
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0136 6030 Case Management Services - 1 Unit Guaranteed Minimum; 3 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0137 6031 Mental Health Family Counseling - 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0138 6050 Administration of Medication - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0139 6051 Mental Health Medication Monitoring - 10 Units Guaranteed Minimum; 30 Units Estimated Maximum Potential Six Month Extension
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0140 5012 Sex Offender Intake Assessment and Report - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Potential Six Month Extension
15BCTS23Q00000004 Page 24 of 68
QUANTITY
UNIT UNIT PRICE AMOUNT
0141 6005 Sex Offender Intake Screening - 1 Unit Guaranteed Minimum;
5 Units Estimated Maximum Potential Six Month Extension
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0142 6012 Sex Offender Individual Counseling - 16 Units Guaranteed Minimum; 120 Units Estimated Maximum Potential Six Month Extension
PSC: G004
16 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0143 6022 Sex Offender Group Counseling - 12 Units Guaranteed Minimum; 180 Units Estimated Maximum Potential Six Month Extension
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0144 6032 Sex Offender Family Counseling - 1 Unit Guaranteed Minimum; 5 Units Estimated Maximum Potential Six Month Extension
15BCTS23Q00000004 Page 25 of 68
Section 3 - Contract Clauses
A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2021)
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)
52.212-4 Contract Terms and Conditions-Commercial Products and Commercial
Services (Nov 2021)
52.203-12 Limitation On Payments To Influence Certain Federal Transactions
(Oct 2010)
52.242-13 Bankruptcy (July 1995)
52.224-1 Privacy Act Notification (Apr 1984)
52.224-2 Privacy Act (Apr 1984)
52.204-12 Unique Entity Identifier Maintenance (Oct 2016)
Clauses By Full Text
52.21-603-70 Contracting Officer's Representative (COR) (June 2012)
15BCTS23Q00000004 Page 26 of 68
(a)Tiffany Olivi SCTC Lead COR, Shannon Hart, Shalini Haylock, Fidencio Lamas, Daniel Reeser, Miriam Guzman and Lei Zhang ,Los Angeles Field Office , 1299 Seaside Avenue, San Pedro, CA 90731,(215) 521-7474, (310) 732-5191, (310) 732-5138, (310)732-5175, (310)732-5526, (310)732-5226, is hereby designated as the Contracting Officer's Representative (COR) under this contract.
(b) The COR is responsible, as applicable, for: receiving all deliverables, inspecting and accepting the supplies or services provide hereunder in accordance with the terms and conditions of this contract; providing direction to the contractor which clarifies the contractor effort, fills in details or otherwise serves to accomplish the contractual Scope of Work; evaluating performance; and certifying all invoices/vouchers for acceptance of the supplies or services furnished for payment.
(c) The COR does not have the authority to alter the contractor's obligations under the contract, and/or modify any of the expressed terms, conditions, specifications, or cost of the agreement. If as a result of technical discussions it is desirable to alter/change contractual obligations or the Scope of Work, the Contracting Officer shall issue such changes.
52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE 2004)
For three of the five years immediately prior to submission of an offer/bid/quote, or prior to performance under a contract or commitment, individuals or contractor employees providing services must have:
1. Legally resided in the United States (U.S.);
2. worked for the U.S. overseas in a Federal or military capacity; or
3. been a dependent of a Federal or military employee serving overseas.
If the individual is not a U.S. citizen, they must be from a country allied with the U.S. The following website provides current information regarding allied countries: http://www.state.gov/s/l/treaty/collectivedefense.
By signing this contract or commitment document, or by commencing performance, the contractor agrees to this restriction.
[End of Clause]
52.218-000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA OR OTHER NATIONAL EMERGENCY (May 2008)
During a Pandemic or other emergency we understand that our contractor workforce will experience the same high levels of absenteeism as our federal employees. Although the Excusable Delays and Termination for Default clauses used in Government contracts list epidemics and quarantine restrictions among the reasons to excuse delays in contract performance, we expect our contractors to make a reasonable effort to keep performance at an acceptable level during emergency periods.
The Office of Personnel Management (OPM) has provided guidance to federal managers and employees on the kinds of actions to be taken to ensure the continuity of operations during emergency periods. This guidance is also applicable to our contract workforce.
Contractors are expected to have reasonable policies in place for continuing work performance, particularly those performing mission critical services, during a pandemic influenza or other emergency situation.
The types of actions a federal contractor should reasonably take to help ensure performance are:
* Encourage employees to get inoculations or follow other preventive measures as advised by the public health service.
* Cross-train workers as backup for all positions performing critical services. This is particularly important for work such as guard services where telework is not an option.
* Implement telework to the greatest extent possible in the workgroup so systems are in place to support successful remote work in an emergency.
* Communicate expectations to all employees regarding their roles and responsibilities in relation to remote work in the event of a pandemic health crisis or other emergency.
* Establish communication processes to notify employees of activation of this plan.
* Integrate pandemic health crisis response expectations into telework agreements.
* With the employee, assess requirements for working at home (supplies and equipment needed for an extended telework period). Security concerns should be considered in making equipment choices; agencies or contractors may wish to avoid use of employees' personal computers and provide them with PCs or laptops as appropriate.
* Determine how all employees who may telework will communicate with one another and with management to accomplish work.
* Practice telework regularly to ensure effectiveness.
* Make it clear that in emergency situations, employees must perform all duties assigned by management, even if they are outside usual or customary duties.
15BCTS23Q00000004 Page 27 of 68
* Identify how time and attendance will be maintained.
It is the contractor's responsibility to advise the Government Contracting Officer if they anticipate not being able to perform and to work with the Department to fill gaps as necessary. This means direct communication with the Contracting Officer or in his/her absence, another responsible person in the contracting office via telephone or email messages acknowledging the contractor's notification. The incumbent contractor is responsible for assisting the Department in estimating the adverse impacts of nonperformance and to work diligently with the Department to develop a strategy for maintaining the continuity of operations.
The Department does reserve the right in such emergency situations to use Federal employees, employees of other agencies, contract support from other existing contractors, or to enter into new contracts for critical support services. Any new contracting efforts would be acquired following the guidance in the Office of federal Procurement Policy issuance "Emergency Acquisitions", May, 2007 and Subpart 18.2. Emergency Acquisition Flexibilities, of the Federal Acquisition Regulations.
[End of Clause]
DJAR-PGD-15-03 Security of Department Information and Systems
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…
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