15BCTS24Q00000015.pdf
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- Solicitation number
- 15BCTS24Q00000015
About this file
This document is a Federal Bureau of Prisons Solicitation for Substance Use, Mental Health, and Sex Offender Treatment Services in Charleston and Clarksburg, West Virginia. The solicitation (Number 15BCTS24Q00000015) seeks community-based outpatient treatment services for male and female Adults in Custody (AICs) at local Residential Reentry Centers, on home confinement, Federal Location Monitoring, or Day Reporting Centers.
The contract includes a one-year base period estimated to begin May 1, 2025, with four one-year option periods and a potential six-month extension. Services are divided into three primary treatment categories: Substance Use Disorder, Mental Health, and Sex Offender Treatment, with varying guaranteed minimum and estimated maximum units for each service type. The solicitation is unrestricted, with quotes due by April 10, 2025, at 2:00 pm EST. The contract will be a firm-fixed price, Indefinite Delivery/Indefinite Quantity (IDIQ) type, with treatment services required within specified geographical radii of federal courthouses in Charleston and Clarksburg, West Virginia.
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15BCTS24Q00000015 Page 1 of 62
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
15BCTS24Q00000015
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
03/10/2025
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Kia Warner k1warner@bop.gov
b. TELEPHONE NUMBER (No collect calls)
(202) 598-6139
8. OFFER DUE DATE / LOCAL
TIME
04/10/2025 12:00 ET
CODE 15BCTS
Federal Bureau of Prisons
Community Treatment Services Contracting
320 First Street NW
Suite 901-5
Washington, DC 20534
9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL BUSINESS
(EDWOSB)
8(A)
NORTH AMERICAN
INDUSTRY CLASSIFICATION
STANDARD (NAICS):
621420
SIZE STANDARD:
$19,000,000
10. THE ACQUISITION IS
SEE SCHEDULE
11. DELIVERY FOR FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
017-24
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER THE
DEFENSE PRIORITIES AND
ALLOCATIONS SYSTEM -
DPAS (15 CFR 700)
13b. RATING
X REQUEST
FOR QUOTE
(RFQ)
INVITATION
FOR BID
(IFB)
REQUEST
FOR
PROPOSAL
(RFP)
14. METHOD OF SOLICITATION
CODE15. DELIVER TO CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Kia Warner
(O) 202-598-6139 k1warner@bop.gov
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B100CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons Mid Atlantic Regional Office 302 Sentinel Drive Suite 200 Annapolis Junction, MD 20701
BOP-RSD-CRBCTS-BILL-DC-
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: 05/01/2025
Substance Use, Mental Health and Sex Offender Treatment Services in Charleston & Clarksburg, WV.
Firm Fixed Price
See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)
X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3
AND 52.212-5 ARE ATTACHED. ADDENDA
ARE X ARE NOT ATTACHED
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED
X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO
ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH
OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE
TERMS AND CONDITIONS SPECIFIED.
29. AWARD OF CONTRACT: REFERENCE _____________________________
OFFER DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK
5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH
HEREIN, IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)
30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (Type or print)
Kia Warner
31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 11/2021)
Prescribed by GSA - FAR (48 CFR) 53.212
15B100 Federal Bureau of Prisons Mid Atlantic Regional Office 302 Sentinel Drive Suite 200 Annapolis Junction, MD 20701
15BCTS24Q00000015 Page 2 of 62
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
15BCTS24Q00000015 Page 3 of 62
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
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) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 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) 52.237-7 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) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (Jan 2025)
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 (Nov 2024) 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) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023)
15BCTS24Q00000015 Page 4 of 62
Section 1 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
Line Period of Performance: 05/01/2025 - 04/30/2026
150 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: 80
Base Period: 1 month through 12 months
Use the Guaranteed Estimated Quantity when developing the total amount.
PSC: G004
80 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: 2400
Base Period: 1 month through 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: 15 Estimated Maximum Quantity: 150
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0005 Co-occurring Intake Assessment & Report (2012) 70 EA $________ $_________________
15BCTS24Q00000015 Page 5 of 62
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 70
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3600
Base Period: 1 month through 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: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
200 EA $________ $_________________
15BCTS24Q00000015 Page 6 of 62
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Base Period: 1 month through 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
0014 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 500
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
500 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: 1 month through 12 months
100 EA $________ $_________________
15BCTS24Q00000015 Page 7 of 62
Use the Estimated Maximum Quantity when developing the total amount.
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: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 800
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Sex Offender Intake Assessment & Report (5012)
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
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: 2 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
20 EA $________ $_________________
15BCTS24Q00000015 Page 8 of 62
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Base Period: 1 month through 12 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 1: 13 months through 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
0025 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
150 EA $________ $_________________
15BCTS24Q00000015 Page 9 of 62
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 70
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
70 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3600
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 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
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
80 EA $________ $_________________
15BCTS24Q00000015 Page 10 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 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
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 1: 13 months through 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
0035 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 500
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
500 EA $________ $_________________
15BCTS24Q00000015 Page 11 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 800
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
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.
25 EA $________ $_________________
15BCTS24Q00000015 Page 12 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 1: 13 months through 24 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
2,400 EA $________ $_________________
15BCTS24Q00000015 Page 13 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 70
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
70 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3600
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
15BCTS24Q00000015 Page 14 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
2,400 EA $________ $_________________
15BCTS24Q00000015 Page 15 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 500
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
500 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0058 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 800
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Sex Offender Intake Assessment & Report (5012)
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.
25 EA $________ $_________________
15BCTS24Q00000015 Page 16 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 2: 25 months through 36 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Sex Offender Individual Counseling (6012)
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
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
80 EA $________ $_________________
15BCTS24Q00000015 Page 17 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 3: 37 months through 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
0067 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 70
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
70 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3600
Option Year 3: 37 months through 48 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
0070 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.
100 EA $________ $_________________
15BCTS24Q00000015 Page 18 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 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.
10 EA $________ $_________________
15BCTS24Q00000015 Page 19 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 3: 37 months through 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
0077 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 500
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
500 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 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
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 800
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
800 EA $________ $_________________
15BCTS24Q00000015 Page 20 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
Option Year 3: 37 months through 48 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
150 EA $________ $_________________
15BCTS24Q00000015 Page 21 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 4: 49 months through 60 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
0088 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 150
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
150 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 70
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
70 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 150 Estimated Maximum Quantity: 3600
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
3,600 EA $________ $_________________
15BCTS24Q00000015 Page 22 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 80
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
80 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
200 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 200
Option Year 4: 49 months through 60 months
15BCTS24Q00000015 Page 23 of 62 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 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
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 2400
Option Year 4: 49 months through 60 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
0098 Case Management Services (6029)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 500
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
500 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
50 EA $________ $_________________
15BCTS24Q00000015 Page 24 of 62 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 800
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 4: 49 months through 60 months
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 1200
1,200 EA $________ $_________________
15BCTS24Q00000015 Page 25 of 62
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 75
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Potential 6 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
0109 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 8 Estimated Maximum Quantity: 75
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Co-occurring Intake Assessment & Report (2012) 35 EA $________ $_________________
15BCTS24Q00000015 Page 26 of 62
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 35
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 75 Estimated Maximum Quantity: 1800
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 40
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
40 EA $________ $_________________
15BCTS24Q00000015 Page 27 of 62
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 100
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
100 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 5
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Potential 6 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 Case Management Services (6029)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 250
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
250 EA $________ $_________________
15BCTS24Q00000015 Page 28 of 62
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0121 MH - Administration of Medication (6050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
25 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 400
Potential 6 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
0123 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
13 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
13 EA $________ $_________________
15BCTS24Q00000015 Page 29 of 62 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 600
Potential 6 Month Extension
Use the Estimated Maximum Quantity when developing the total amount.
600 EA $________ $_________________
15BCTS24Q00000015 Page 30 of 62
Section 2 - Contract Clauses
A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023)
The terms and conditions for the following clauses are hereby incorporated into this solicitation and resulting contract as an addendum to FAR clause 52.212-4.
Clauses By Reference
52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)
This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.acquisition.gov
Clause Title Fill-ins (if applicable)
52.242-15 Stop-Work Order (Aug 1989)
52.224-1 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)
52.204-18 Commercial and Government Entity Code Maintenance
(Aug 2020)
52.212-4 Contract Terms…
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