15BCTS24Q00000011.pdf
PDF 365 KB Posted
- Attached to
- SU/MH/SOT in Manchester, NH Federal contract opportunity
- Solicitation number
- 15BCTS24Q00000011
About this file
This is a Standard Form 1449 (SF-1449) Solicitation/Contract/Order for Commercial Products and Commercial Services issued by the Federal Bureau of Prisons (BOP) Community Treatment Services Contracting office for outpatient substance use disorder, mental health, and sex offender treatment services in Manchester, NH.
The solicitation (15BCTS24Q00000011) is a 100% small business set-aside with a NAICS code of 621420 and $19 million size standard. Services must be provided within a 5-mile radius of Manchester City Hall and be accessible by public transportation. The period of performance includes a one-year base period starting April 1, 2025, plus four one-year option periods and a potential 6-month extension. The contract is an Indefinite Delivery Indefinite Quantity (IDIQ) with firm-fixed unit prices. Services include various types of counseling, assessments, evaluations, and treatment planning with specified minimum and maximum quantities for each service type. All treatment services must be provided by clinicians licensed to practice independently in New Hampshire. Quotes are due by December 30, 2024 at 12:00 PM ET. The solicitation will be available on SAM.gov starting November 27, 2024.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions 3 Regarding 15BCTS24Q00000011.pdf | ||
| Questions 2 Regarding 15BCTS24Q00000011.pdf | ||
| Questions Regarding 15BCTS24Q00000011.pdf | ||
| Statement of Work 2022.pdf | ||
| Whistleblower Info.pdf | ||
| Cover Letter.pdf | ||
| Section 2.1, Continuation of SF-1449.pdf | ||
| Technical Quotation Information Packet.docx | DOCX document | |
| Quotation Attachment Form.xlsx | XLSX spreadsheet | |
| Business Quotation Information Packet.pdf |
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Text version
15BCTS24Q00000011 Page 1 of 80
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
15BCTS24Q00000011
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
11/27/2024
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Shuwona Jones sjones2@bop.gov
b. TELEPHONE NUMBER (No collect calls)
202-598-6128
8. OFFER DUE DATE / LOCAL
TIME
12/30/2024 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
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER THE
DEFENSE PRIORITIES AND
ALLOCATIONS SYSTEM -
DPAS (15 CFR 700)
13b. RATING
X REQUEST
FOR QUOTE
(RFQ)
INVITATION
FOR BID
(IFB)
REQUEST
FOR
PROPOSAL
(RFP)
14. METHOD OF SOLICITATION
15B200CODE15. DELIVER TO
Federal Bureau of Prisons Northeast Regional Office
US CUSTOM HOUSE, 7TH FLOOR
2ND & CHESTNUT
Philadelphia, PA 19106
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Shuwona Jones
(O) 202-598-6128 sjones2@bop.gov
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B200CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons Northeast Regional Office
US CUSTOM HOUSE, 7TH FLOOR
2ND & CHESTNUT
Philadelphia, PA 19106
BOP-RSD-CRBCTS-BILL-PHL-
S@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: 04/01/2025 Outpatient Substance Use Disorder (SU), Mental Health (MH) & Sex Offender Treatment (SOT) Services in Manchester, NH.
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)
Shuwona Jones
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
RCA-011-24
15BCTS24Q00000011 Page 2 of 80
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
15BCTS24Q00000011 Page 3 of 80
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
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) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.242-13 Bankruptcy (July 1995) 52.242-15 Stop-Work Order (Aug 1989) 52.253-1 Computer Generated Forms (Jan 1991) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.202-1 Definitions (Jun 2020) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.226-8 Encouraging Contractor Policies To Ban Text Messaging While Driving (May 2024) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS
(APR 2011)
DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency (OCT 2007) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (May 2024) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (May 2024) 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)
3 List of Attachments 4 Solicitation Provisions
52.204-22 Alternative Line Item Proposal (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-7 System for Award Management (Oct 2018) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 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) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.216-1 Type of Contract (Apr 1984) 52.217-5 Evaluation of Options (July 1990) 52.233-2 Service of Protest (Sept 2006)
15BCTS24Q00000011 Page 4 of 80
2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023)
15BCTS24Q00000011 Page 5 of 80
Section 1 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Base Period: Date of award - 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
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: Date of award - 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
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 2400
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Base Period: Date of award - 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
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
50 EA $________ $_________________
15BCTS24Q00000011 Page 6 of 80
Base Period: Date of award - 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: 240 Estimated Maximum Quantity: 3600
Base Period: Date of award - 12 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
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 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: Date of award - 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: 2 Estimated Maximum Quantity: 25
Base Period: Date of award - 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: Date of award - 12 months
15BCTS24Q00000011 Page 7 of 80
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: Date of award - 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: Date of award - 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: 40 Estimated Maximum Quantity: 1200
Base Period: Date of award - 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
0014 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 800
Base Period: Date of award - 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
0015 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
100 EA $________ $_________________
15BCTS24Q00000011 Page 8 of 80
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Base Period: Date of award - 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
0017 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Base Period: Date of award - 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
0018 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 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
0019 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: Date of award - 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
0020 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
20 EA $________ $_________________
15BCTS24Q00000011 Page 9 of 80
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Sex Offender Group Counseling (6022)
Guaranteed Minimum; Quantity: 4 Estimated Maximum Quantity: 400
Base Period: Date of award - 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: Date of award - 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
0024 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 1: 13 - 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
0025 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 10 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 1: 13 - 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
0028 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 - 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 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 240 Estimated Maximum Quantity: 3600
Option Year 1: 13 - 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
0030 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 11 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 - 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
0032 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 1: 13 - 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
0033 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity:5 Estimated Maximum Quantity: 50
Option Year 1: 13 - 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
0034 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 - 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
0035 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
10 EA $________ $_________________
15BCTS24Q00000011 Page 12 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 1200
Option Year 1: 13 - 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
0037 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 800
Option Year 1: 13 - 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
0038 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 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
0039 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 1: 13 - 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
0040 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 13 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 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
0042 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 - 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
0043 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Sex Offender Group Counseling (6022)
Guaranteed Minimum; Quantity: 4 Estimated Maximum Quantity: 400
Option Year 1: 13 - 24 months
Use the Estimated Maximum Quantity when developing the total amount.
400 EA $________ $_________________
15BCTS24Q00000011 Page 14 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 - 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
0047 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 2: 25 - 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
0048 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0049 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 15 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0052 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 240 Estimated Maximum Quantity: 3600
Option Year 2: 25 - 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
0053 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 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
0054 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0055 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
25 EA $________ $_________________
15BCTS24Q00000011 Page 16 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity:5 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0057 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0058 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 - 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
0059 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 1200
Option Year 2: 25 - 36 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
0060 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 800
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
800 EA $________ $_________________
15BCTS24Q00000011 Page 17 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 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
0062 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 2: 25 - 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
0063 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 2: 25 - 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
0064 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 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
0065 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 18 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Sex Offender Group Counseling (6022)
Guaranteed Minimum; Quantity: 4 Estimated Maximum Quantity: 400
Option Year 2: 25 - 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 - 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
0070 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 19 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 3: 37 - 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
0072 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
2,400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 3: 37 - 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
0074 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 - 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
0075 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 240 Estimated Maximum Quantity: 3600
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
3,600 EA $________ $_________________
15BCTS24Q00000011 Page 20 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 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
0077 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 - 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
0078 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 - 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
0079 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity:5 Estimated Maximum Quantity: 50
Option Year 3: 37 - 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
0080 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 21 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 3: 37 - 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
0082 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 1200
Option Year 3: 37 - 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
0083 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 800
Option Year 3: 37 - 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
0084 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 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
0085 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 22 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 3: 37 - 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
0087 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 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
0088 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 - 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
0089 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
600 EA $________ $_________________
15BCTS24Q00000011 Page 23 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Sex Offender Group Counseling (6022)
Guaranteed Minimum; Quantity: 4 Estimated Maximum Quantity: 400
Option Year 3: 37 - 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 - 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
0093 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 4: 49 - 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
0094 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 - 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
0095 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 100 Estimated Maximum Quantity: 2400
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
2,400 EA $________ $_________________
15BCTS24Q00000011 Page 24 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 4: 49 - 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
0097 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 - 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
0098 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 240 Estimated Maximum Quantity: 3600
Option Year 4: 49 - 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
0099 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 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
0100 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 25 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 4: 49 - 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
0102 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity:5 Estimated Maximum Quantity: 50
Option Year 4: 49 - 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
0103 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 - 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
0104 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 4: 49 - 60 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
0105 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 40 Estimated Maximum Quantity: 1200
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
1,200 EA $________ $_________________
15BCTS24Q00000011 Page 26 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 800
Option Year 4: 49 - 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
0107 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 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
0108 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 4: 49 - 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
0109 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Option Year 4: 49 - 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
0110 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 27 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 - 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
0112 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Sex Offender Group Counseling (6022)
Guaranteed Minimum; Quantity: 4 Estimated Maximum Quantity: 400
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Sex Offender Relationship and Parenting Counseling (6032)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 - 60 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 28 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 (2001) Substance Use Disorder Treatment Planning and Follow-up
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Potential Six-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
0117 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential Six-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
0118 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum; Quantity: 50 Estimated Maximum Quantity: 1200
Potential Six-Month Extension
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
0119 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Potential Six-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
0120 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential Six-Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 29 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 1800
Potential Six-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
0122 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential Six-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
0123 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential Six-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
0124 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential Six-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
0125 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential Six-Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 30 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential Six-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
0127 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
Potential Six-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
0128 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 600
Potential Six-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
0129 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 400
Potential Six-Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
400 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential Six-Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000011 Page 31 of 80
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential Six-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
0132 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Potential Six-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
0133 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential Six-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
0134 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential Six-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
0135 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Potential…
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