15BCTS23Q00000024 Bridgeton NJ.pdf
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- 15BCTS23Q00000024 - SUD/MH/SOT in Bridgeton, NJ
- Solicitation number
- 15BCTS23Q00000024
About this file
This is a solicitation for substance use disorder, mental health, and sex offender treatment services in Bridgeton, New Jersey. The solicitation requires individual and group counseling, intake assessments, treatment planning, medication monitoring and other behavioral health services. The period of performance is 60 months including four 12-month base periods and four 6-month option periods. The Bureau of Prisons is the awarding agency. Offerors must submit pricing for minimum and maximum quantities of each required service item by the proposal due date of December 4, 2023. Award is anticipated to be a firm-fixed-price contract.
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Other files
| File | Type | Posted |
|---|---|---|
| 2 - Section 2.1, Continuation SF-1449.pdf | ||
| 6 - Whistleblower Information.pdf | ||
| 5 - Business Quotation Information Packet.pdf | ||
| 3 - 2022 Statement of Work (SOW).pdf | ||
| 7 - Subcontracting Plan 01-2023.pdf | ||
| 1 - Cover Letter.pdf | ||
| 4 - Technical Quotation Information Packet.docx | DOCX document | |
| 8 - Attachment Quotation Form.xlsx | XLSX spreadsheet |
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15BCTS23Q00000024 Page 1 of 64
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
15BCTS23Q00000024
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
11/03/2023
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Joo (Jan) Walker j15walker@bop.gov
b. TELEPHONE NUMBER (No collect calls)
(202) 451-7924
8. OFFER DUE DATE / LOCAL
TIME
12/04/2023 12:00 ET
CODE 15BCTS
Federal Bureau of Prisons
Community Treatment Services Contracting
320 First Street NW, Suite 901-5
Washington, DC 20534
9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(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
15B200CODE15. DELIVER TO
Federal Bureau of Prisons Northeast Regional Office
US CUSTOM HOUSE, 7TH FLOOR
2ND & CHESTNUT
Philadelphia, PA 19106
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW, Suite 901-5 Washington, DC 20534
Joo (Jan) Walker
(O) 202-451-7924 j15walker@bop.gov
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B200CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons Northeast Regional Office
US CUSTOM HOUSE, 7TH FLOOR
2ND & CHESTNUT
Philadelphia, PA 19106
BOP-RSD-CRBCTS-BILL-PHL@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: 01/01/2024
Substance Use, Mental Health, and Sex Offender Treatment Services in Bridgeton, NJ.
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)
Joo (Jan) Walker
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
024-23
15BCTS23Q00000024 Page 2 of 64
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
15BCTS23Q00000024 Page 3 of 64
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) 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)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR
2011) DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency
(OCT 2007)
DOJ-05 Security of Department Information and Systems DOJ-05 (OCT 2023) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Sep 2023) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.217-5 Evaluation of Options (July 1990) 52.242-15 Stop-Work Order (Aug 1989) 52.203-3 Gratuities (Apr 1984) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-13 System for Award Management Maintenance (Oct 2018) 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) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020)
3 List of Attachments 4 Solicitation Provisions
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) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.204-7 System for Award Management (Oct 2018) 52.204-22 Alternative Line Item Proposal (Jan 2017)
15BCTS23Q00000024 Page 4 of 64
Section 1 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0001 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 100 Estimated Maximum Quantity: 2400
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020) 3,960 $________ $_________________
15BCTS23Q00000024 Page 5 of 64
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0010 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0012 Crisis Intervention Evaluation & Report (6000) 10 $________ $_________________
15BCTS23Q00000024 Page 6 of 64
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0014 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0015 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0016 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
150 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0017 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0018 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
50 $________ $_________________
15BCTS23Q00000024 Page 7 of 64
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0019 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0020 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 620
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
620 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0021 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0022 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0023 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0024 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2
40 $________ $_________________
15BCTS23Q00000024 Page 8 of 64
Estimated Maximum Quantity: 40
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0025 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0026 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0027 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0028 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
3,960 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0029 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0030 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3
75 $________ $_________________
15BCTS23Q00000024 Page 9 of 64
Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0031 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0032 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0033 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0034 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
10 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0035 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0036 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
1,800 $________ $_________________
15BCTS23Q00000024 Page 10 of 64
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0037 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0038 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
150 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0039 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0040 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0041 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0042 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 620
620 $________ $_________________
15BCTS23Q00000024 Page 11 of 64
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0043 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0044 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0045 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0046 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0047 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0048 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15
15BCTS23Q00000024 Page 12 of 64
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0049 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0050 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
3,960 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0051 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0052 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0053 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0054 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3
15BCTS23Q00000024 Page 13 of 64
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0055 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0056 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
10 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0057 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0058 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0059 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0060 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
150 $________ $_________________
15BCTS23Q00000024 Page 14 of 64
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0061 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0062 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0063 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0064 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 620
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
620 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0065 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 2: 25 months through 36 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0066 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
100 $________ $_________________
15BCTS23Q00000024 Page 15 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0067 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0068 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0069 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0070 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0071 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0072 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 3: 37 months through 48 months
3,960 $________ $_________________
15BCTS23Q00000024 Page 16 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0073 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0074 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0075 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0076 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0077 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0078 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
10 $________ $_________________
15BCTS23Q00000024 Page 17 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0079 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0080 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0081 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0082 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
150 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0083 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0084 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
15BCTS23Q00000024 Page 18 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0085 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0086 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 620
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
620 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0087 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0088 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0089 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0090 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 4: 49 months through 60 months
40 $________ $_________________
15BCTS23Q00000024 Page 19 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0091 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0092 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0093 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0094 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
3,960 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0095 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0096 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
15BCTS23Q00000024 Page 20 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0097 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
40 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0098 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0099 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
75 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0100 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
10 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0101 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
2,400 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0102 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
1,800 $________ $_________________
15BCTS23Q00000024 Page 21 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0103 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0104 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
150 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0105 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0106 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0107 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0108 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 620
620 $________ $_________________
15BCTS23Q00000024 Page 22 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0109 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 1800
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,800 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0110 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
100 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0111 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
38 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0112 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
20 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0113 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 1200
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0114 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 38
Potential 6 Month Extension
38 $________ $_________________
15BCTS23Q00000024 Page 23 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0115 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0116 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1980
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,980 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0117 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0118 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
38 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0119 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
20 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0120 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 38
38 $________ $_________________
15BCTS23Q00000024 Page 24 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0121 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
38 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0122 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
5 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0123 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 1200
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
1,200 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0124 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 900
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
900 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0125 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
50 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0126 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 75
15BCTS23Q00000024 Page 25 of 64 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0127 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0128 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
25 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0129 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
13 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0130 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 310
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
310 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0131 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 900
Potential 6 Month Extension
Use the Guaranteed Maximum Quantity when developing the total amount.
PSC: G004
900 $________ $_________________
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0132 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
15BCTS23Q00000024 Page 26 of 64 amount.
PSC: G004
15BCTS23Q00000024 Page 27 of 64
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)
52.203-12 Limitation On…
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