15BCTS24Q00000008.pdf
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- Attached to
- SU/MH in Jacksonville, FL Federal contract opportunity
- Solicitation number
- 15BCTS24Q00000008
About this file
This document is a solicitation (Request for Quotation) for a firm-fixed price contract to provide community-based outpatient substance use disorder and mental health treatment services to male and female adults in custody residing in a Residential Reentry Center, on home confinement, or on Federal Location Monitoring in Jacksonville, Florida.
The performance period is for a one-year base period estimated to begin on October 1, 2024, with four one-year option periods, for a total potential performance period of five years. The solicitation will be set aside for total small business. The guaranteed minimum and estimated maximum quantities are provided for various treatment services across substance use disorder and mental health categories. Responses to the solicitation are due by May 22, 2024 at 2:00 pm EST. The contracting agency is the Federal Bureau of Prisons (BOP) Central Office.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions 3 for 15BCTS24Q00000008.pdf | ||
| Questions 2 for 15BCTS24Q00000008.pdf | ||
| Corrected 2022 Statement of Work.pdf | ||
| Signed Amendment 3 - 15BCTS24Q00000008.pdf | ||
| Signed Amendment 2 15BCTS24Q00000008.pdf | ||
| Corrected Section 2.1, Continuation SF1449 Jacksonville, FL.pdf | ||
| Questions for 15BCTS24Q00000008.pdf | ||
| Corrected Section 2.1, Continuation SF1449 Jacksonville, FL.docx | DOCX document | |
| 15BCTS24Q00000008 - Amendment 1.pdf | ||
| Technical Quotation Information Packet Jacksonville FL.docx | DOCX document | |
| Attachment Quotation Form.xlsx | XLSX spreadsheet | |
| Cover Letter Jacksonville FL.pdf | ||
| APN 22-03 Whistleblower Information.pdf | ||
| CTS Statement of Work 2022.pdf | ||
| Business Quotation Information Packet.pdf | ||
| Section 2.1, Continuation SF1449 Jacksonville, FL.pdf |
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15BCTS24Q00000008 Page 1 of 74
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
15BCTS24Q00000008
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
04/22/2024
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Kia Warner k1warner@bop.gov
b. TELEPHONE NUMBER (No collect calls)
(202) 598-6139
8. OFFER DUE DATE / LOCAL
TIME
05/22/2024 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 UNRESTRICTED OR X SET ASIDE:100.00 % FOR
X SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL BUSINESS
(EDWOSB)
8(A)
NORTH AMERICAN
INDUSTRY CLASSIFICATION
STANDARD (NAICS):
621420
SIZE STANDARD:
$19,000,000
10. THE ACQUISITION IS
SEE SCHEDULE
11. DELIVERY FOR FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
008-24
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
15B300CODE15. DELIVER TO
Federal Bureau of Prisons South East Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
CODE 15BCTS16. ADMINISTERED BY
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
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B300CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons South East Regional Office 3800 Camp Creek PKWY SW Building 2000 Atlanta, GA 30331
BOP-RSD-CRBCTS-BILL-ATL@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: 10/01/2024
Substance Use and Mental Health Treatment Services in Jacksonville, FL.
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)
Kia Warner
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
15BCTS24Q00000008 Page 2 of 74
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
15BCTS24Q00000008 Page 3 of 74
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)
15BCTS24Q00000008 Page 4 of 74
52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023)
15BCTS24Q00000008 Page 5 of 74
Section 1 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Estimated Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1600
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,600 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: 50
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
25 EA $________ $_________________
15BCTS24Q00000008 Page 6 of 74
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3600
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
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
100 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: 50
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
50 EA $________ $_________________
15BCTS24Q00000008 Page 7 of 74
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 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
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 800
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
900 EA $________ $_________________
15BCTS24Q00000008 Page 8 of 74
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Mental Health Relationship and Parenting Counseling (6031)
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
100 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
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: 300
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Substance Use Disorder Intake Screening (2005)
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.
15BCTS24Q00000008 Page 9 of 74
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1600
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3600
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 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.
100 EA $________ $_________________
15BCTS24Q00000008 Page 10 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Mental Health Intake Screening (5005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 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.
10 EA $________ $_________________
15BCTS24Q00000008 Page 11 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 800
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 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.
15BCTS24Q00000008 Page 12 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 300
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Substance Use Disorder Intake Screening (2005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1600
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000008 Page 13 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3600
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 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
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Mental Health Intake Screening (5005)
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.
15BCTS24Q00000008 Page 14 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 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
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 800
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
1,200 EA $________ $_________________
15BCTS24Q00000008 Page 15 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 300
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000008 Page 16 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Substance Use Disorder Intake Screening (2005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1600
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3600
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
3,600 EA $________ $_________________
15BCTS24Q00000008 Page 17 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 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
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Mental Health Intake Screening (5005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000008 Page 18 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 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
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 800
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 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 Estimated Maximum Quantity when developing the total amount.
100 EA $________ $_________________
15BCTS24Q00000008 Page 19 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 MH - Administration of Medication (6050)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 300
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
300 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: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Substance Use Disorder Intake Screening (2005)
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
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1600
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total
1,600 EA $________ $_________________
15BCTS24Q00000008 Page 20 of 74
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: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 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: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3600
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
3,600 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 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5
15BCTS24Q00000008 Page 21 of 74
Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Mental Health Intake Screening (5005)
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
25 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: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 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 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
10 EA $________ $_________________
15BCTS24Q00000008 Page 22 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 800
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 900
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
900 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 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 Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 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 4: 49 months through 60 months
15BCTS24Q00000008 Page 23 of 74 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 300
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
13 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 800
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Substance Use Disorder Intake Assessment & Report (2011) 25 EA $________ $_________________
15BCTS24Q00000008 Page 24 of 74
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
13 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1800
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000008 Page 25 of 74
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
13 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 400
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total
400 EA $________ $_________________
15BCTS24Q00000008 Page 26 of 74
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 600
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Case Management Services (6029)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 450
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
450 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
13 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 150
Potential 6 Month Extension
150 EA $________ $_________________
15BCTS24Q00000008 Page 27 of 74
15BCTS24Q00000008 Page 28 of 74
Section 2 - Contract Clauses
52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023)
(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights--
(1) Within a reasonable time after the defect was discovered or should have been discovered; and
(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.
(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.
(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.
(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at Federal Acquisition Regulation (FAR) 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.
(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.
(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.
(g) Invoice.
(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include--
(i) Name and address of the Contractor;
(ii) Invoice date and number;
(iii) Contract number, line item number and, if applicable, the order number;
(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;
(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;
(vi) Terms of any discount for prompt payment offered;
15BCTS24Q00000008 Page 29 of 74
(vii) Name and address of official to whom payment is to be sent;
(viii) Name, title, and phone number of person to notify in event of defective invoice; and
(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.
(x) Electronic funds transfer (EFT) banking information.
(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.
(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer--System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer--Other Than System for Award Management), or applicable agency procedures.
(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.
(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR Part 1315.
(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.
(i) Payment.--
(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.
(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR Part 1315.
(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.
(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.
(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall--
(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the--
(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);
(B) Affected contract number and delivery order number, if applicable;
(C) Affected line item or subline item, if applicable; and
(D) Contractor point of contact.
(ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer.
(6) Interest.
15BCTS24Q00000008 Page 30 of 74
(i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in 41 U.S.C.
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