15BCTS24Q00000007 - Amendment 1.pdf
PDF 290 KB Posted
- Attached to
- SU/MH/SOT in Memphis, TN Federal contract opportunity
- Solicitation number
- 15BCTS24Q00000007
About this file
This document is an amendment to a solicitation for Substance Use Disorder, Mental Health, and Sex Offender Treatment Services in Memphis, TN. The solicitation number is 15BCTS24Q00000007.
The amendment adds Contract Line-Item Numbers (CLINs) for Option Year Four to the solicitation. The CLINs for Option Year Four cover a range of substance use, mental health, and sex offender treatment services including treatment planning, intake screening, individual and group counseling, assessments, and related services. The estimated performance period is from 49 months through 60 months. The solicitation is set-aside for small businesses. Responses are due on or about May 22, 2024 by 2:00 pm EST. The Federal Bureau of Prisons Central Office is the contracting agency.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions 3 for 15BCTS24Q00000007.pdf | ||
| Questions 2 for 15BCTS24Q00000007.pdf | ||
| Amendment 3 - 15BCTS24Q00000007.pdf | ||
| Corrected 2022 Statement of Work.pdf | ||
| Signed Amendment 2 15BCTS24Q00000007.pdf | ||
| Questions for 15BCTS24Q00000007.pdf | ||
| CTS Statement of Work 2022.pdf | ||
| Technical Quotation Information Packet Memphis TN.docx | DOCX document | |
| Cover Letter Memphis TN.pdf | ||
| 15BCTS24Q00000007.pdf | ||
| Section 2.1, Continuation SF1449 Memphis, TN.pdf | ||
| Business Quotation Information Packet.pdf | ||
| APN 22-03 Whistleblower Information.pdf | ||
| Attachment Quotation Form.xlsx | XLSX spreadsheet |
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Text version
15BCTS24Q00000007/0001 Page 1 of 80
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
1. CONTRACT ID CODE PAGE OF PAGES
1 80
2. AMENDMENT/MODIFICATION NUMBER
3. EFFECTIVE DATE
04/23/2024
4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)
15BCTSCODE
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Kia Warner
(O) (202) 598-6139 k1warner@bop.gov
6. ISSUED BY CODE7. ADMINISTERED BY (If other than Item 6)
9A. AMENDMENT OF SOLICITATION NUMBER
15BCTS24Q00000007
CODE FACILITY CODE
8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)
X 9B. DATED (SEE ITEM 11)
04/22/2024
10A. MODIFICATION OF CONTRACT/ORDER
NUMBER
10B. DATED (SEE ITEM 13)
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
X XThe above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning __1__copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
12. ACCOUNTING AND APPROPRIATION DATA (If required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.
IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.
CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NUMBER IN ITEM 10A.
B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
D. OTHER (Specify type of modification and authority)
E. IMPORTANT: Contractor is not, is required to sign this document and return _______ copies to the issuing office.
14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)
Amendment 1 is hereby issued to add Contract Line-Item Numbers (CLINs) for Option Year Four to the solicitation. The CLINs for Option Year Four are from CLIN 0097 to 0120.
Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)
Kia Warner Contracting Officer
(Signature of person authorized to sign)
15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED
By (Signature of Contracting Officer)
16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
Previous edition unusable STANDARD FORM 30 (REV. 11/2016) Prescribed by GSA FAR (48 CFR) 53.243
4/23/2024
1 X
15BCTS24Q00000007/0001 Page 2 of 80
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 52.242-15 Stop-Work Order (Aug 1989) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.253-1 Computer Generated Forms (Jan 1991) 52.203-3 Gratuities (Apr 1984) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.242-13 Bankruptcy (July 1995) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.216-19 Order Limitations (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS
(APR 2011)
52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-01 Whistleblower Information Distribution (Oct 2021) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) 52.216-22 Indefinite Quantity (Oct 1995) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.216-18 Ordering (Aug 2020) 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 DOJ-05 (OCT 2023) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (Feb 2024)
3 List of Attachments 4 Solicitation Provisions
52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.204-7 System for Award Management (Oct 2018) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.216-1 Type of Contract (Apr 1984) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020)
3.1 INSTRUCTIONS TO OFFERORS - COMMERCIAL SERVICES
52.209-7 Information Regarding Responsibility Matters (Oct 2018)
15BCTS24Q00000007/0001 Page 3 of 80
52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023)
15BCTS24Q00000007/0001 Page 4 of 80
Section 1 - Commodity or Services Schedule
Substance Use, Mental Health and Sex Offender Treatment Services in Memphis, TN.
Firm Fixed Price
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)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Estimated Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 64 Estimated Maximum Quantity: 1400
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
1,400
Change: 0
Current :
1,400
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
15BCTS24Q00000007/0001 Page 5 of 80
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3000
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
3,000
Change: 0
Current :
3,000
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Previous :
Change: 0
15BCTS24Q00000007/0001 Page 6 of 80
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Current : 50
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 480
Previous :
15BCTS24Q00000007/0001 Page 7 of 80
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Change: 0
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 600
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 250
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS24Q00000007/0001 Page 8 of 80
0019 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 480
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
15BCTS24Q00000007/0001 Page 9 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 64 Estimated Maximum Quantity: 1400
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
1,400
Change: 0
Current :
1,400
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Previous :
15BCTS24Q00000007/0001 Page 10 of 80 amount.
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3000
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
3,000
Change: 0
Current :
3,000
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 11 of 80
0033 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
15BCTS24Q00000007/0001 Page 12 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 480
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 600
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 250
Option Year 1: 13 months through 24 months
Previous :
15BCTS24Q00000007/0001 Page 13 of 80 amount.
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 480
Previous :
15BCTS24Q00000007/0001 Page 14 of 80
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Change: 0
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 64 Estimated Maximum Quantity: 1400
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
1,400
Change: 0
Current :
1,400
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 15 of 80
0052 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3000
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
3,000
Change: 0
Current :
3,000
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
15BCTS24Q00000007/0001 Page 16 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
Previous :
15BCTS24Q00000007/0001 Page 17 of 80
PSC: G004 Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 480
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 600
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 18 of 80
0066 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 250
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
15BCTS24Q00000007/0001 Page 19 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 480
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 64 Estimated Maximum Quantity: 1400
Option Year 3: 37 months through 48 months
Previous :
1,400
15BCTS24Q00000007/0001 Page 20 of 80 amount.
PSC: G004
Current :
1,400
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3000
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
3,000
Change: 0
Current :
3,000
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 21 of 80
0080 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 10
15BCTS24Q00000007/0001 Page 22 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 480
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 600
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Previous :
15BCTS24Q00000007/0001 Page 23 of 80 amount.
PSC: G004
Current : 25
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 250
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
Option Year 3: 37 months through 48 months
Previous :
15BCTS24Q00000007/0001 Page 24 of 80 amount.
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 480
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 25
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 25 of 80
0099 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 64 Estimated Maximum Quantity: 1400
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
1,400
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 40
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 20
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3000
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
1,500
Change:
1,500
Current :
3,000
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Previous :
Change: 50
15BCTS24Q00000007/0001 Page 26 of 80 amount.
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 25
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
0108 Crisis Intervention Evaluation & Report (6000) Previous : 5 EA $________ $_________________
15BCTS24Q00000007/0001 Page 27 of 80
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Change: 5
Current : 10
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 800
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 480
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 600
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Previous :
Change: 50
15BCTS24Q00000007/0001 Page 28 of 80 amount.
PSC: G004
Current :
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 12
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 250
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 12
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 12
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000007/0001 Page 29 of 80
0117 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 10
Current : 20
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 400
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 480
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 50
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Previous : 0
Change: 50
Current : 50
15BCTS24Q00000007/0001 Page 30 of 80 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous : 0
Change: 25
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 32 Estimated Maximum Quantity: 700
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous : 0
Change:
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity:…
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