Signed Amendment 3 - 15BCTS24Q00000008.pdf
PDF 340 KB Posted
- Attached to
- SU/MH in Jacksonville, FL Federal contract opportunity
- Solicitation number
- 15BCTS24Q00000008
About this file
This document is an amendment to a solicitation for Substance Use and Mental Health Treatment Services in Jacksonville, FL. The solicitation is being issued by the Federal Bureau of Prisons (BOP) Community Treatment Services (CTS) Contracting Office. The contract will be a firm-fixed price contract with a one-year base period beginning October 1, 2024 and four one-year option periods, for a total potential contract duration of five years.
The required services include substance use disorder treatment, mental health treatment, and related services such as intake assessments, counseling, medication management, and case management. The solicitation includes specific service CLINs with guaranteed minimum and estimated maximum quantities for each contract period. The total small business set-aside solicitation is expected to be available on or about April 22, 2024, with quotes due by May 22, 2024. The BOP anticipates awarding the contract to a responsible small business concern.
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 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 | ||
| Cover Letter Jacksonville FL.pdf | ||
| APN 22-03 Whistleblower Information.pdf | ||
| 15BCTS24Q00000008.pdf | ||
| Section 2.1, Continuation SF1449 Jacksonville, FL.pdf | ||
| CTS Statement of Work 2022.pdf | ||
| Business Quotation Information Packet.pdf | ||
| Technical Quotation Information Packet Jacksonville FL.docx | DOCX document | |
| Attachment Quotation Form.xlsx | XLSX spreadsheet |
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Text version
15BCTS24Q00000008/0003 Page 1 of 72
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
1. CONTRACT ID CODE PAGE OF PAGES
1 72
2. AMENDMENT/MODIFICATION NUMBER
3. EFFECTIVE DATE
05/23/2024
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
15BCTS24Q00000008
CODE FACILITY CODE
8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)
X 9B. DATED (SEE ITEM 11)
05/22/2024
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 3 is hereby issued to:
1. Correct the clerical error on the SF-30 Schedule of Supplies correcting CLIN 0006 - Substance Use Disorder Group Counseling (2020)'s Estimated Maximum Quantity to 3,600.
2. Incorporate a corrected copy of the Statement of Work (SOW). This copy of the SOW corrects a clerical error found in section 4.6.1 from CLIN 6031 to CLIN 6029.
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
05/23/2024 Previous edition unusable STANDARD FORM 30 (REV. 11/2016)
Prescribed by GSA FAR (48 CFR) 53.243
15BCTS24Q00000008/0003 Page 2 of 72
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)
15BCTS24Q00000008/0003 Page 3 of 72
52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023)
15BCTS24Q00000008/0003 Page 4 of 72
Section 1 - Commodity or Services Schedule
Substance Use and Mental Health Treatment Services in Jacksonville, FL.
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: 50
Base Period: 1 month through 12 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
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
Previous :
Change: 0
Current : 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
Previous :
1,600
Change: 0
Current :
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
15BCTS24Q00000008/0003 Page 5 of 72
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
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
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
Previous :
3,000
Change:
Current :
3,600
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: 50
Base Period: 1 month through 12 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
0009 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Previous :
Change: 0
15BCTS24Q00000008/0003 Page 6 of 72
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Current : 25
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
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
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
Previous :
Change: 0
Current : 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
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: 30 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: 12 Estimated Maximum Quantity: 1200
Base Period: 1 month through 12 months
Previous :
1,200
15BCTS24Q00000008/0003 Page 7 of 72 amount.
PSC: G004
Current :
1,200
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.
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: 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
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: 300
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
15BCTS24Q00000008/0003 Page 8 of 72
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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
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
Previous :
1,600
Change: 0
Current :
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000008/0003 Page 9 of 72
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
Previous :
3,600
Change: 0
Current :
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.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
15BCTS24Q00000008/0003 Page 10 of 72
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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current :
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
Previous :
1,200
Change: 0
Current :
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.
Previous :
15BCTS24Q00000008/0003 Page 11 of 72
PSC: G004 Current :
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
Previous :
Change: 0
Current :
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.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current :
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
Previous :
Change: 0
Current : 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
Previous :
15BCTS24Q00000008/0003 Page 12 of 72
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Change: 0
Current : 25
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
Previous :
1,600
Change: 0
Current :
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.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 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
Previous :
3,600
Change: 0
Current :
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
Previous :
15BCTS24Q00000008/0003 Page 13 of 72
Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 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
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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Previous :
15BCTS24Q00000008/0003 Page 14 of 72
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Change: 0
Current : 10
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
Previous :
Change: 0
Current :
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.
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current :
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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000008/0003 Page 15 of 72
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current :
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.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 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
Previous :
1,600
Change: 0
Current :
1,600
15BCTS24Q00000008/0003 Page 16 of 72
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
3,600
Change: 0
Current :
3,600
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current :
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.
Previous :
Change: 0
15BCTS24Q00000008/0003 Page 17 of 72
PSC: G004
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 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
Previous :
15BCTS24Q00000008/0003 Page 18 of 72
Current :
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
Previous :
1,200
Change: 0
Current :
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
Previous :
Change: 0
Current :
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.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000008/0003 Page 19 of 72
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
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: 50
Option Year 4: 49 months through 60 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
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
Previous :
Change: 0
Current : 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 amount.
PSC: G004
Previous :
1,600
Change: 0
Current :
1,600
EA $________ $_________________
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.
Previous :
Change: 0
15BCTS24Q00000008/0003 Page 20 of 72
PSC: G004
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
Previous :
Change: 0
Current : 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
Previous :
3,600
Change: 0
Current :
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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 Mental Health Treatment Planning and Follow-up (5001)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000008/0003 Page 21 of 72
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 10
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
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.
Previous :
15BCTS24Q00000008/0003 Page 22 of 72
PSC: G004 Current :
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
Previous :
1,200
Change: 0
Current :
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
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: 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: 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 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS24Q00000008/0003 Page 23 of 72
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
Previous :
Change: 0
Current :
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current : 25
15BCTS24Q00000008/0003 Page 24 of 72
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
Previous :
Change: 0
Current : 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
Previous :
1,800
Change: 0
Current :
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
Previous :
Change: 0
Current : 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.
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Previous :
15BCTS24Q00000008/0003 Page 25 of 72 amount.
PSC: G004
Current : 13
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Previous : 5
Change: 0
Current : 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 amount.
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 600
Previous :
15BCTS24Q00000008/0003 Page 26 of 72
Potential 6 Month Extension
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
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
Previous :
Change: 0
Current :
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
Previous :
Change: 0
Current : 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
Previous :
Change: 0
Current : 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
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Previous :
Change: 0
Current :
15BCTS24Q00000008/0003 Page 27 of 72
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;
15BCTS24Q00000008/0003 Page 28 of 72
(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…
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