15BCTS25Q00000010 SF 1449 Sioux Falls SD Final.pdf

15BCTS25Q00000010 Page 1 of 50

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

15BCTS25Q00000010

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

07/01/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Wade O'Quinn woquinn@bop.gov

b. TELEPHONE NUMBER (No collect calls)

276-546-0150 ext. 4144

8. OFFER DUE DATE / LOCAL

TIME

08/01/2025 14:00 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

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

Wade O'Quinn

(O) 276-546-0150 Ext. 4144 woquinn@bop.gov

FACILITY

CODE

CODE

TELEPHONE NUMBER

17a. CONTRACTOR/

OFFEROR

15B400CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons North Central Regional Office

400 STATE AVENUE

SUITE 800

Kansas City, KS 66101

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: 09/01/2025

Substance Use, Mental Health, and Sex Offender Treatment Services in Sioux Falls, SD 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)

Wade Oquinn

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

Federal Bureau of Prisons North Central Regional Office 400 STATE AVENUE

SUITE 800

Kansas City, KS 66101

020-25

15BCTS25Q00000010 Page 2 of 50

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

15BCTS25Q00000010 Page 3 of 50

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) 52.204-13 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) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.242-13 Bankruptcy (July 1995) 52.242-15 Stop-Work Order (Aug 1989) 52.252-6 Authorized Deviations in Clauses (Nov 2020) 52.253-1 Computer Generated Forms (Jan 1991) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 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)

3 List of Attachments 4 Solicitation Provisions

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 (Nov 2024) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.217-5 Evaluation of Options (July 1990) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.216-1 Type of Contract (Apr 1984) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020)

15BCTS25Q00000010 Page 4 of 50

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)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Disorder Individual Counseling (2010)

240 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

40 EA $________ $_________________

15BCTS25Q00000010 Page 5 of 50

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020)

150 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 Mental Health Treatment Planning and Follow-up (5001)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Mental Health Intake Screening (5005)

5 Units Guaranteed Minimum; 60 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 Mental Health Intake Assessment & Report (5011)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

90 EA $________ $_________________

15BCTS25Q00000010 Page 6 of 50

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Psychiatric Evaluation & Report (5030)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Mental Health Individual Counseling (6010)

180 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 MH- Medication Monitoring & Reporting (6051)

10 Units Guaranteed Minimum; 400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS25Q00000010 Page 7 of 50

0016 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 15 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Sex Offender Individual Counseling (6012)

4 Units Guaranteed Minimum; 240 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

240 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Base Period: 1 month through 12 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

80 EA $________ $_________________

15BCTS25Q00000010 Page 8 of 50

Option Year 1: 13 months through 24 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Substance Use Disorder Intake Screening (2005)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Substance Use Disorder Individual Counseling (2010)

240 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Disorder Group Counseling (2020)

150 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

2,400 EA $________ $_________________

15BCTS25Q00000010 Page 9 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Mental Health Treatment Planning and Follow-up (5001)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Mental Health Intake Screening (5005)

5 Units Guaranteed Minimum; 60 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Mental Health Intake Assessment & Report (5011)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Psychiatric Evaluation & Report (5030)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 10 of 50

0032 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Mental Health Individual Counseling (6010)

180 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 MH- Medication Monitoring & Reporting (6051)

10 Units Guaranteed Minimum; 400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

20 EA $________ $_________________

15BCTS25Q00000010 Page 11 of 50

Option Year 1: 13 months through 24 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 15 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Sex Offender Individual Counseling (6012)

4 Units Guaranteed Minimum; 240 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

240 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 1: 13 months through 24 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Substance Use Disorder Intake Screening (2005)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

50 EA $________ $_________________

15BCTS25Q00000010 Page 12 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Substance Use Disorder Individual Counseling (2010)

240 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Substance Use Disorder Group Counseling (2020)

150 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 13 of 50

0048 Mental Health Treatment Planning and Follow-up (5001)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Mental Health Intake Screening (5005)

5 Units Guaranteed Minimum; 60 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Mental Health Intake Assessment & Report (5011)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Psychiatric Evaluation & Report (5030)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Mental Health Individual Counseling (6010)

180 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

1,800 EA $________ $_________________

15BCTS25Q00000010 Page 14 of 50

Option Year 2: 25 months through 36 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 MH- Medication Monitoring & Reporting (6051)

10 Units Guaranteed Minimum; 400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 15 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

15 EA $________ $_________________

15BCTS25Q00000010 Page 15 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Sex Offender Individual Counseling (6012)

4 Units Guaranteed Minimum; 240 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

240 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 2: 25 months through 36 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Substance Use Disorder Intake Screening (2005)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Substance Use Disorder Individual Counseling (2010)

240 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 16 of 50

0064 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Substance Use Disorder Group Counseling (2020)

150 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Mental Health Treatment Planning and Follow-up (5001)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Mental Health Intake Screening (5005)

5 Units Guaranteed Minimum; 60 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

60 EA $________ $_________________

15BCTS25Q00000010 Page 17 of 50

Option Year 3: 37 months through 48 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Mental Health Intake Assessment & Report (5011)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Psychiatric Evaluation & Report (5030)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Mental Health Individual Counseling (6010)

180 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

100 EA $________ $_________________

15BCTS25Q00000010 Page 18 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 MH- Medication Monitoring & Reporting (6051)

10 Units Guaranteed Minimum; 400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 15 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Sex Offender Individual Counseling (6012)

4 Units Guaranteed Minimum; 240 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

240 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 19 of 50

0080 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 3: 37 months through 48 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Substance Use Disorder Intake Screening (2005)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Substance Use Disorder Individual Counseling (2010)

240 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 80 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

80 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

15BCTS25Q00000010 Page 20 of 50

Option Year 4: 49 months through 60 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Substance Use Disorder Group Counseling (2020)

150 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Mental Health Treatment Planning and Follow-up (5001)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Mental Health Intake Screening (5005)

5 Units Guaranteed Minimum; 60 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Mental Health Intake Assessment & Report (5011)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

90 EA $________ $_________________

15BCTS25Q00000010 Page 21 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Psychiatric Evaluation & Report (5030)

10 Units Guaranteed Minimum; 90 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Mental Health Individual Counseling (6010)

180 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 MH- Medication Monitoring & Reporting (6051)

10 Units Guaranteed Minimum; 400 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 22 of 50

0096 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0097 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 15 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 Sex Offender Individual Counseling (6012)

4 Units Guaranteed Minimum; 240 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

240 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0100 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Option Year 4: 49 months through 60 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

15BCTS25Q00000010 Page 23 of 50

Potential 6 Month Extension

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Substance Use Disorder Intake Screening (2005)

3 Units Guaranteed Minimum; 25 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

25 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Substance Use Disorder Individual Counseling (2010)

120 Units Guaranteed Minimum; 900 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Co-occurring Intake Assessment & Report (2012)

3 Units Guaranteed Minimum; 20 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Substance Use Disorder Group Counseling (2020)

75 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

1,200 EA $________ $_________________

15BCTS25Q00000010 Page 24 of 50

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Substance Use Disorder Relationship and Parenting Counseling (2030)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0108 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 45 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

45 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 Mental Health Intake Screening (5005)

3 Units Guaranteed Minimum; 30 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 45 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

45 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 45 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

45 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS25Q00000010 Page 25 of 50

0112 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 5 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0113 Mental Health Individual Counseling (6010)

90 Units Guaranteed Minimum; 900 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Mental Health Relationship and Parenting Counseling (6031)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 MH- Medication Monitoring & Reporting (6051)

5 Units Guaranteed Minimum; 200 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Sex Offender Treatment Disorder Treatment Planning and Follow-up(6001)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total

10 EA $________ $_________________

15BCTS25Q00000010 Page 26 of 50

Potential 6 Month Extension

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 8 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 Sex Offender Individual Counseling (6012)

2 Units Guaranteed Minimum; 120 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0120 Sex Offender Relationship and Parenting Counseling (6032)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Use the Estimated Maximum Quantity when developing the total amount.

Potential 6 Month Extension

50 EA $________ $_________________

15BCTS25Q00000010 Page 27 of 50

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)

52.203-3 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)

52.204-13 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)

52.224-1 Privacy Act Notification (Apr 1984)

52.224-2 Privacy Act (Apr 1984)

52.232-40 Providing Accelerated Payments to Small Business

Subcontractors (Mar 2023)

52.242-13 Bankruptcy (July 1995)

52.242-15 Stop-Work Order (Aug 1989)

52.252-6 Authorized Deviations in Clauses (Nov 2020)

52.253-1 Computer Generated Forms (Jan 1991)

15BCTS25Q00000010 Page 28 of 50

Clauses By Full Text

52.21-603-70 Contracting Officer's Representative (COR) (June 2012)

(a)Lashanda Williams, Tyler Johnson, Tesia Easley, Misty Hoffer, Hector Montoya, Jennifer Pearson, Sarah Ramsey, North Central Regional Office, 400 State Avenue, Tower II Suite 800, Kansas City, KS 66101,202-305-5234, 202-598-9336, 202-451-7601,913-551-1063 913-551-1081, 405-262-4875 x 7664, 202-598-6556, , is hereby designated as the Contracting Officer's

Representative (COR) under this contract.

(b) The COR is responsible, as applicable, for: receiving all deliverables, inspecting and accepting the supplies or services provide hereunder in accordance with the terms and conditions of this contract; providing direction to the contractor which clarifies the contractor effort, fills in details or otherwise serves to accomplish the contractual Scope of Work; evaluating performance; and certifying all invoices/vouchers for acceptance of the supplies or services furnished for payment.

(c) The COR does not have the authority to alter the contractor's obligations under the contract, and/or modify any of the expressed terms, conditions, specifications, or cost of the agreement. If as a result of technical discussions it is desirable to alter/change contractual obligations or the Scope of Work, the Contracting Officer shall issue such changes.

52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)

(a) Definitions. As used in this clause--

"Covered contractor information system" means an information system that is owned or operated by a contractor that processes, stores, or transmits Federal contract information.

"Federal contract information" means information, not intended for public release, that is provided by or generated for the Government under a contract to develop or deliver a product or service to the Government, but not including information provided by the Government to the public (such as on public Web sites) or simple transactional information, such as necessary to process payments.

"Information" means any communication or representation of knowledge such as facts, data, or opinions, in any medium or form, including textual, numerical, graphic, cartographic, narrative, or audiovisual (Committee on National Security Systems Instruction (CNSSI) 4009).

"Information system" means a discrete set of information resources organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition of information (44 U.S.C. 3502).

"Safeguarding" means measures or controls that are prescribed to protect information systems.

(b) Safeguarding requirements and procedures.

(1) The Contractor shall…