15BCTS23Q00000021.pdf

15BCTS23Q00000021 Page 1 of 79

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

15BCTS23Q00000021

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

05/08/2023

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Roderick Bryant rbryant1@bop.gov

b. TELEPHONE NUMBER (No collect calls)

(202) 451-7925

8. OFFER DUE DATE / LOCAL

TIME

06/07/2023 13:00 CT

CODE 15BCTS

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

Roderick Bryant

(O) (202) 451-7925 rbryant1@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: 08/01/2023

Substance Use, Mental Health, Medication Assisted Treatment, and Sex Offender Treatment Services in Baton Rouge 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)

Gary 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

021-23

15BCTS23Q00000021 Page 2 of 79

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

15BCTS23Q00000021 Page 3 of 79

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) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)

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

2011) DOJ-01 Whistleblower Information Distribution (Oct 2021) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Mar 2023) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 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) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency

(OCT 2007)

DOJ-05 Security of Department Information and Systems (APR 2015) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.242-13 Bankruptcy (July 1995) 52.253-1 Computer Generated Forms (Jan 1991) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.203-3 Gratuities (Apr 1984) 52.242-15 Stop-Work Order (Aug 1989) 52.204-13 System for Award Management Maintenance (Oct 2018)

3 List of Attachments 4 Solicitation Provisions

52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Dec 2022) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.216-1 Type of Contract (Apr 1984) 52.233-2 Service of Protest (Sept 2006) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.217-5 Evaluation of Options (July 1990) 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)

15BCTS23Q00000021 Page 4 of 79

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)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

15 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

Use the Guaranteed Minimum Quantity when developing the total amount.

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)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

15 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

5 EA $________ $_________________

15BCTS23Q00000021 Page 5 of 79

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

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

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

2 EA $________ $_________________

15BCTS23Q00000021 Page 6 of 79

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Mental Health Intake Assessment & Report (5011)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Psychiatric Evaluation & Report (5030)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

1 EA $________ $_________________

15BCTS23Q00000021 Page 7 of 79

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Mental Health Group Counseling (6020)

24 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

15BCTS23Q00000021 Page 8 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Base Period: Date of award - 12 months

15BCTS23Q00000021 Page 9 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

5 EA $________ $_________________

15BCTS23Q00000021 Page 10 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS23Q00000021 Page 11 of 79

0036 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Mental Health Intake Assessment & Report (5011)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Psychiatric Evaluation & Report (5030)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

0041 Mental Health Individual Counseling (6010) 20 EA $________ $_________________

15BCTS23Q00000021 Page 12 of 79

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Mental Health Group Counseling (6020)

24 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

15BCTS23Q00000021 Page 13 of 79 amount.

Option Year 1: 13 months through 24 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

15 EA $________ $_________________

15BCTS23Q00000021 Page 14 of 79

Option Year 2: 25 months through 36 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

120 EA $________ $_________________

15BCTS23Q00000021 Page 15 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000021 Page 16 of 79

0062 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Mental Health Intake Assessment & Report (5011)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Psychiatric Evaluation & Report (5030)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

0067 Mental Health Group Counseling (6020) 24 EA $________ $_________________

15BCTS23Q00000021 Page 17 of 79

24 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

15BCTS23Q00000021 Page 18 of 79 amount.

Option Year 2: 25 months through 36 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total

15BCTS23Q00000021 Page 19 of 79

Option Year 3: 37 months through 48 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000021 Page 20 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

15BCTS23Q00000021 Page 21 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Mental Health Intake Assessment & Report (5011)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Psychiatric Evaluation & Report (5030)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Mental Health Group Counseling (6020)

24 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

24 EA $________ $_________________

15BCTS23Q00000021 Page 22 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0097 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

15BCTS23Q00000021 Page 23 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0100 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

15BCTS23Q00000021 Page 24 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000021 Page 25 of 79

0108 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

0113 Mental Health Intake Assessment & Report (5011) 6 EA $________ $_________________

15BCTS23Q00000021 Page 26 of 79

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Psychiatric Evaluation & Report (5030)

6 Units Guaranteed Minimum; 75 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Mental Health Group Counseling (6020)

24 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

15BCTS23Q00000021 Page 27 of 79 amount.

Option Year 4: 49 months through 60 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0120 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0122 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0123 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total

20 EA $________ $_________________

15BCTS23Q00000021 Page 28 of 79

Option Year 4: 49 months through 60 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0124 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0125 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0126 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 38 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0127 Substance Use Disorder Intake Screening (2005)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0128 Substance Use Disorder Individual Counseling (2010)

50 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

50 EA $________ $_________________

15BCTS23Q00000021 Page 29 of 79

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0129 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 38 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0130 Co-occurring Intake Assessment & Report (2012)

3 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0131 Substance Use Disorder Group Counseling (2020)

60 Units Guaranteed Minimum; 1980 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0132 Substance Use Disorder Relationship and Parenting Counseling (2030)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0133 MAT – Follow-Up & Report (4004)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

15BCTS23Q00000021 Page 30 of 79

QUANTITY

UNIT UNIT PRICE AMOUNT

0134 MAT - Intake Screening (4005)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0135 MAT Psychiatric Evaluation & Report (4050)

1 Unit Guaranteed Minimum; 25 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0136 Mental Health Treatment Planning and Follow-up (5001)

3 Units Guaranteed Minimum; 38 Units Estimated Maximum

Use the Guaranteed Minimum Quantity when developing the total…