15BCTS23Q00000018 5-16-23.pdf

15BCTS23Q00000018 Page 1 of 69

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 AND 30.

1. REQUISITION NUMBER PAGE 1 OF

5. SOLICITATION NUMBER

15BCTS23Q00000018

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

05/16/2023

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

06/01/2023 02:00 ET

CODE BCTS

Federal Bureau of Prisons

Community Treatment Services Contracting

320 First Street NW

Suite 901-5

Washington, DC 20534

9. ISSUED BY UNRESTRICTED OR X SET ASIDE:100.00 % FOR

X SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL BUSINESS

(EDWOSB)

8(A)

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

621420

SIZE STANDARD:

$19,000,000

10. THE ACQUISITION IS

SEE SCHEDULE

11. DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER THE

DEFENSE PRIORITIES AND

ALLOCATIONS SYSTEM -

DPAS (15 CFR 700)

13b. RATING

X REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

14. METHOD OF SOLICITATION

15B500CODE15. DELIVER TO

Federal Bureau of Prisons South Central Regional Office 344 Marine Forces Drive Grand Prairie, TX 75051

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 NUMBER

17a. CONTRACTOR/

OFFEROR

15B500CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons South Central Regional Office 344 Marine Forces Drive Grand Prairie, TX 75051

BOP-RSD-CRBCTS-BILL-DAL@bop.gov

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Delivery Date: 07/01/2023

Substance Use, Mental Health and Sex Offender Treatment Services in Youngstown, OH.

Firm Fixed Price

See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

ARE X ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REFERENCE _____________________________

OFFER DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK

5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (Type or print)

Paul Clark

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

023 - 18

15BCTS23Q00000018 Page 2 of 69

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 11/2021) BACK

15BCTS23Q00000018 Page 3 of 69

Table of Contents

Section Description Page Number

Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses

52.21-603-70 Contracting Officer's Representative (COR) (June 2012) DOJ-05 Security of Department Information and Systems (APR 2015) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability Of Funds (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR

2011) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (June 2016) DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021); (Alt. I) -- Classified Information -- Cleared Contractors 52.216-22 Indefinite Quantity (Oct 1995) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency

(OCT 2007)

DOJ-02 Contractor Privacy Requirements (JAN 2022) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 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 (Mar 2023) 52.242-15 Stop-Work Order (Aug 1989) 52.203-3 Gratuities (Apr 1984) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.253-1 Computer Generated Forms (Jan 1991) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 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) 52.204-13 System for Award Management Maintenance (Oct 2018)

3 List of Attachments 4 Solicitation Provisions

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) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Dec 2019) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Dec 2019) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Dec 2022) 52.204-16 Commercial and Government Entity Code Reporting (Jul 2016) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.204-7 System for Award Management (Oct 2018) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Mar 2023) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017)

15BCTS23Q00000018 Page 4 of 69

Section 1 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0001 Substance Use Disorder Treatment Planning and Follow-up (2001) 5 Units Guaranteed Minimum; 75 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Disorder Individual Counseling (2010) 60 Units Guaranteed Minimum; 1200 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 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 Co-occurring Intake Assessment & Report (2012) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020) 120 Units Guaranteed Minimum; 3960 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS23Q00000018 Page 5 of 69

0007 Substance Use Disorder Relationship and Parenting Counseling (2030) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Base Period: Date of Award to 12 Months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 Mental Health Treatment Planning and Follow-up (5001) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Base Period: Date of Award to 12 Months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Mental Health Intake Screening (5005) 2 Unit Guaranteed Minimum;

35 Units Estimated Maximum Base Period: Date of Award to 12 Months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 Mental Health Intake Assessment & Report (5011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Psychiatric Evaluation & Report (5030) 10 Units Guaranteed Minimum; 75 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 Crisis Intervention Evaluation & Report (6000) 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

0013 Mental Health Individual Counseling (6010) 20 Units Guaranteed Minimum; 1280 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Mental Health Group Counseling (6020) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

15BCTS23Q00000018 Page 6 of 69

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 Mental Health Relationship and Parenting Counseling (6031) 2 Units Guaranteed Minimum; 640 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 MH-Medication Monitoring and Report (6051) 5 Units Guaranteed Minimum; 200 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Sex Offender Specific Intake Assessment & Report (5012) 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 25 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 Sex Offender Intake Screening (6005) 1 Unit Guaranteed Minimum; 20 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Sex Offender Individual Counseling (6012) 2 Units Guaranteed Minimum; 320 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 Sex Offender Group Counseling (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Sex Offender Relationship and Parenting Counseling (6032) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum

2 EA $________ $_________________

15BCTS23Q00000018 Page 7 of 69

Base Period: Date of award - 12 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Substance Use Disorder Treatment Planning and Follow-up (2001) 5 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Substance Use Disorder Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Substance Use Disorder Individual Counseling (2010) 60 Units Guaranteed Minimum; 1200 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Disorder Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Co-occurring Intake Assessment & Report (2012) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Substance Use Disorder Group Counseling (2020) 120 Units Guaranteed Minimum; 3960 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Substance Use Disorder Relationship and Parenting Counseling (2030) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 1: 13 months to 24 months

15BCTS23Q00000018 Page 8 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Mental Health Treatment Planning and Follow-up (5001) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Mental Health Intake Screening (5005) 2 Unit Guaranteed Minimum;

35 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Mental Health Intake Assessment & Report (5011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Psychiatric Evaluation & Report (5030) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Crisis Intervention Evaluation & Report (6000) 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Mental Health Individual Counseling (6010) 20 Units Guaranteed Minimum; 1280 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Mental Health Group Counseling (6020) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000018 Page 9 of 69

0037 Mental Health Relationship and Parenting Counseling (6031) 2 Units Guaranteed Minimum; 640 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 MH-Medication Monitoring and Report (6051) 5 Units Guaranteed Minimum; 200 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Sex Offender Specific Intake Assessment & Report (5012) 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 25 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Sex Offender Intake Screening (6005) 1 Unit Guaranteed Minimum; 20 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Sex Offender Individual Counseling (6012) 2 Units Guaranteed Minimum; 320 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Sex Offender Group Counseling (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum Option Year 1: 13 months to 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 Sex Offender Relationship and Parenting Counseling (6032) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 1: 13 months to 24 months

15BCTS23Q00000018 Page 10 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Substance Use Disorder Treatment Planning and Follow-up (2001) 5 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Substance Use Disorder Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Substance Use Disorder Individual Counseling (2010) 60 Units Guaranteed Minimum; 1200 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Substance Use Disorder Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Co-occurring Intake Assessment & Report (2012) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Substance Use Disorder Group Counseling (2020) 120 Units Guaranteed Minimum; 3960 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Substance Use Disorder Relationship and Parenting Counseling (2030) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000018 Page 11 of 69

0052 Mental Health Treatment Planning and Follow-up (5001) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Mental Health Intake Screening (5005) 2 Unit Guaranteed Minimum;

35 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Mental Health Intake Assessment & Report (5011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Psychiatric Evaluation & Report (5030) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Crisis Intervention Evaluation & Report (6000) 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Mental Health Individual Counseling (6010) 20 Units Guaranteed Minimum; 1280 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Mental Health Group Counseling (6020) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Mental Health Relationship and Parenting Counseling (6031) 2 Units Guaranteed Minimum; 640 Units Estimated Maximum Option Year 2: 25 months to 36 months

15BCTS23Q00000018 Page 12 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 MH-Medication Monitoring and Report (6051) 5 Units Guaranteed Minimum; 200 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Sex Offender Specific Intake Assessment & Report (5012) 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 25 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Sex Offender Intake Screening (6005) 1 Unit Guaranteed Minimum; 20 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Sex Offender Individual Counseling (6012) 2 Units Guaranteed Minimum; 320 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Sex Offender Group Counseling (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Sex Offender Relationship and Parenting Counseling (6032) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 2: 25 months to 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Substance Use Disorder Treatment Planning and Follow-up (2001) 5 Units Guaranteed Minimum; 75 Units Estimated Maximum

5 EA $________ $_________________

15BCTS23Q00000018 Page 13 of 69

Option Year 3: 37 months to 48 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Substance Use Disorder Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Substance Use Disorder Individual Counseling (2010) 60 Units Guaranteed Minimum; 1200 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Substance Use Disorder Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Co-occurring Intake Assessment & Report (2012) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Substance Use Disorder Group Counseling (2020) 120 Units Guaranteed Minimum; 3960 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Substance Use Disorder Relationship and Parenting Counseling (2030) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Mental Health Treatment Planning and Follow-up (5001) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 3: 37 months to 48 months

15BCTS23Q00000018 Page 14 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 Mental Health Intake Screening (5005) 2 Unit Guaranteed Minimum;

35 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Mental Health Intake Assessment & Report (5011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Psychiatric Evaluation & Report (5030) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Crisis Intervention Evaluation & Report (6000) 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Mental Health Individual Counseling (6010) 20 Units Guaranteed Minimum; 1280 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 Mental Health Group Counseling (6020) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Mental Health Relationship and Parenting Counseling (6031) 2 Units Guaranteed Minimum; 640 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000018 Page 15 of 69

0082 MH-Medication Monitoring and Report (6051) 5 Units Guaranteed Minimum; 200 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Sex Offender Specific Intake Assessment & Report (5012) 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 25 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Sex Offender Intake Screening (6005) 1 Unit Guaranteed Minimum; 20 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Sex Offender Individual Counseling (6012) 2 Units Guaranteed Minimum; 320 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Sex Offender Group Counseling (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Sex Offender Relationship and Parenting Counseling (6032) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 3: 37 months to 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Substance Use Disorder Treatment Planning and Follow-up (2001) 5 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 4: 49 months to 60 months

15BCTS23Q00000018 Page 16 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Substance Use Disorder Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Substance Use Disorder Individual Counseling (2010) 60 Units Guaranteed Minimum; 1200 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Substance Use Disorder Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Co-occurring Intake Assessment & Report (2012) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Substance Use Disorder Group Counseling (2020) 120 Units Guaranteed Minimum; 3960 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 Substance Use Disorder Relationship and Parenting Counseling (2030) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 Mental Health Treatment Planning and Follow-up (5001) 5 Units Guaranteed Minimum; 50 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000018 Page 17 of 69

0097 Mental Health Intake Screening (5005) 2 Unit Guaranteed Minimum;

35 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Mental Health Intake Assessment & Report (5011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 Psychiatric Evaluation & Report (5030) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0100 Crisis Intervention Evaluation & Report (6000) 1 Unit Guaranteed Minimum; 10 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Mental Health Individual Counseling (6010) 20 Units Guaranteed Minimum; 1280 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Mental Health Group Counseling (6020) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Mental Health Relationship and Parenting Counseling (6031) 2 Units Guaranteed Minimum; 640 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 MH-Medication Monitoring and Report (6051) 5 Units Guaranteed Minimum; 200 Units Estimated Maximum Option Year 4: 49 months to 60 months

15BCTS23Q00000018 Page 18 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Sex Offender Specific Intake Assessment & Report (5012) 5 Units Guaranteed Minimum; 25 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 25 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Sex Offender Intake Screening (6005) 1 Unit Guaranteed Minimum; 20 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0108 Sex Offender Individual Counseling (6012) 2 Units Guaranteed Minimum; 320 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 Sex Offender Group Counseling (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 Sex Offender Relationship and Parenting Counseling (6032) 2 Units Guaranteed Minimum; 100 Units Estimated Maximum Option Year 4: 49 months to 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Substance Use Disorder Treatment Planning and Follow-up (2001) 3 Units Guaranteed Minimum; 38 Units Estimated Maximum Potential Six Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Substance Use Disorder Intake Screening (2005) 1 Unit Guaranteed

1 EA $________ $_________________

15BCTS23Q00000018 Page 19 of 69

Minimum; 13 Units Estimated Maximum Potential Six Month Extension

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0113 Substance Use Disorder Individual Counseling (2010) 30 Units Guaranteed Minimum; 600 Units Estimated Maximum Potential Six Month Extension

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Substance Use Disorder Intake Assessment & Report (2011) 5 Units Guaranteed Minimum; 38 Units Estimated Maximum Potential Six Month Extension

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Co-occurring Intake Assessment & Report (2012) 3 Units Guaranteed Minimum; 25 Units Estimated Maximum Potential Six Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Substance Use Disorder Group Counseling (2020) 60 Units Guaranteed Minimum; 1980 Units Estimated Maximum Potential Six Month Extension

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Substance Use Disorder Relationship and Parenting Counseling (2030) 1 Unit Guaranteed Minimum; 50 Units Estimated Maximum Potential Six Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Mental Health Treatment Planning and Follow-up (5001) 3 Units Guaranteed Minimum; 25 Units Estimated Maximum Potential Six Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 Mental Health Intake Screening (5005) 1 Unit Guaranteed Minimum;

18 Units Estimated Maximum Potential Six Month Extension

15BCTS23Q00000018 Page 20 of 69

QUANTITY

UNIT UNIT PRICE AMOUNT

0120 Mental Health Intake Assessment & Report (5011) 5 Units Guaranteed Minimum; 38 Units Estimated Maximum Potential Six Month Extension

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Psychiatric Evaluation & Report (5030) 5 Units Guaranteed Minimum; 38 Units Estimated Maximum Potential Six Month Extension

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0122 Crisis Intervention Evaluation & Report (6000) 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

0123 Mental Health Individual Counseling (6010) 10 Units Guaranteed Minimum; 640 Units Estimated Maximum Potential Six Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0124 Mental Health Group Counseling (6020) 2 Units Guaranteed Minimum; 50 Units Estimated Maximum Potential Six Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0125 Mental Health Relationship and Parenting Counseling (6031) 1 Unit Guaranteed Minimum; 320 Units Estimated Maximum Potential Six Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0126 MH-Medication Monitoring and Report (6051) 3 Units Guaranteed Minimum; 100 Units Estimated Maximum Potential Six Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0127 Sex Offender Specific Intake Assessment & Report (5012) 3 Units Guaranteed Minimum; 13 Units Estimated Maximum

3 EA $________ $_________________

15BCTS23Q00000018 Page 21 of 69

Potential Six Month Extension

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0128 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001) 1 Unit Guaranteed Minimum; 13 Units Estimated Maximum Potential Six Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0129 Sex Offender Intake Screening (6005) 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

0130 Sex Offender Individual Counseling (6012) 1 Unit Guaranteed Minimum; 160 Units Estimated Maximum Potential Six Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0131 Sex Offender Group Counseling (6022) 2 Units Guaranteed Minimum; 480 Units Estimated Maximum Potential Six Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0132 Sex Offender Relationship and Parenting Counseling (6032) 1 Unit Guaranteed Minimum; 50 Units Estimated Maximum Potential Six Month Extension

15BCTS23Q00000018 Page 22 of 69

Section 2 - 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

(Mar 2023)

52.253-1 Computer Generated Forms (Jan 1991)

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial

Services (Dec 2022)

52.203-12 Limitation On Payments to Influence Certain Federal Transactions

(Jun 2020)

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)

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

Clauses By Full Text

15BCTS23Q00000018 Page 23 of 69

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):

https://www.acquisition.gov/browse/index/far [Insert one or more Internet addresses]

(End of clause)

52.21-603-70 Contracting Officer's Representative (COR) (June 2012)

(a)Sandra Hargeshelmer, SCTC, 215-521-7470, Nicole Foster, CTC, 215-521-7472, Cynthia Benik CTOS, 215-521-7499, Ashanti Black, CTOS, 215-521-7491, Sabina Medyinsky, CTOS, 215-5217461, Ewelina Rozkuszka, CTOS, 215-521-7446, Jeanine Stank CTOS, 215-521-7471, Mayelin Ugarte MA, 215-521-7475 ,[Title] , 200 Chesnut Street, 7th Fl., Philadelphia, PA. 19106,[Area Code and Telephone Number], 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

15BCTS23Q00000018 Page 24 of 69 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 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…