1. SF1449.pdf
PDF 387 KB Posted
- Attached to
- 15BCTS25Q00000014 - SU/MH/SOT in Wichita, KS
- Solicitation number
- 15BCTS25Q00000014
About this file
This is an Amendment of Solicitation/Modification of Contract (Standard Form 30) issued by the Federal Bureau of Prisons for solicitation 15BCTS25Q00000014. The amendment extends the solicitation closing date to October 13, 2026 at 14:00 ET. The underlying solicitation seeks mental health and substance use disorder treatment services in Wichita, Kansas on a Firm Fixed Price, Indefinite Delivery Indefinite Quantity (IDIQ) contract basis with a base period of 12 months and up to four one-year option periods, plus a potential six-month extension.
The schedule of supplies and services includes 120 line items organized by treatment type: substance use disorder services (treatment planning, intake screening, individual and group counseling, assessments), mental health services (treatment planning, intake screening, individual counseling, psychiatric evaluations, medication monitoring), sex offender treatment services (intake assessments, treatment planning, individual and group counseling), and crisis intervention services. Quantities range from guaranteed minimums to estimated maximums across all periods. Pricing must be submitted on an SF-1449 form with separate Business and Technical Quotation Information Packets. Offerors must have Active SAM registration, current professional liability insurance of at least $1 million per occurrence, and must submit completed attestation forms addressing cybersecurity and vendor requirements. Electronic submissions via email to rbryant1@bop.gov in PDF format are required with a 180-day acceptance period. The contract includes extensive DOJ-specific clauses addressing personnel security requirements (Public Trust positions with background investigations), privacy and records management, contractor employee reporting, cybersecurity safeguarding, and pandemic performance continuity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 11. Additional Questions.docx | DOCX document | |
| 10. Base SF-1449.pdf | ||
| 9. Combined Solicitation - Wichita, KS.pdf | ||
| 1. SF 1449.pdf | ||
| 3. Technical Quotation Information Request.docx | DOCX document | |
| 0. Solicitation Cover Letter (Wichita, KS).pdf | ||
| 1a. Combined Solicitation - Wichita, KS.pdf | ||
| 7. Statement of Work (2022).pdf | ||
| 8. Whistleblower Information.pdf | ||
| 0. Solicitation Cover Letter (Wichita, KS).pdf | ||
| 1. Wichita Solicitation (SF-1449).pdf | ||
| 2. Attachment Quotation Form.xlsx | XLSX spreadsheet | |
| 3. Technical Quotation Information Request.docx | DOCX document | |
| 4. Business Quotation Information Packet.pdf | ||
| 6. ATU Vendor Attestation.pdf | ||
| 5. Pricing Chart.docx | DOCX document |
Show all 16
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Text version
15BCTS25Q00000014/0002 Page 1 of 52
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
1. CONTRACT ID CODE PAGE OF PAGES
1 52
2. AMENDMENT/MODIFICATION NUMBER
3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)
15BCTSCODE
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534
Roderick D. Bryant
(O) 202-598-6128 rbryant1@bop.gov
6. ISSUED BY CODE7. ADMINISTERED BY (If other than Item 6)
9A. AMENDMENT OF SOLICITATION NUMBER
15BCTS25Q00000014
CODE FACILITY CODE
8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)
X 9B. DATED (SEE ITEM 11)
09/11/2026
10A. MODIFICATION OF CONTRACT/ORDER
NUMBER
10B. DATED (SEE ITEM 13)
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
X XThe above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning __1__copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
12. ACCOUNTING AND APPROPRIATION DATA (If required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.
IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.
CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NUMBER IN ITEM 10A.
B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
D. OTHER (Specify type of modification and authority)
E. IMPORTANT: Contractor is not, is required to sign this document and return _______ copies to the issuing office.
14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)
Modification 002 hereby changes the closing date of this solicitation to October 13, 2026 at 14:00pm EST.
THIS AMENDMENT EXTENDS THE SOLICITATION CLOSING DATE/TIME TO: 10/13/2026 - 14:00 ET US/Eastern
Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)
Roderick D Bryant Contracting Officer
(Signature of person authorized to sign)
15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED
By (Signature of Contracting Officer)
16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
Previous edition unusable STANDARD FORM 30 (REV. 11/2016) Prescribed by GSA FAR (48 CFR) 53.243
15BCTS25Q00000014/0002 Page 2 of 52
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
52.203-6 Alt I Restrictions on Subcontractor Sales to the Government (Jun 2020) - Alternate I (Nov 2021) 52.204-13 (DEV) System for Award Management-Maintenance (Oct 2018) (DEVIATION NOV 2025) 52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014) 52.204-91 (DEV) Contractor Identification (DEVIATION NOV 2025) 52.209-6 (DEV) Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded (Jan 2025)
(DEVIATION NOV 2025)
52.212-4 (DEV) Terms and Conditions-Commercial Products and Commercial Services (Nov
2023) (DEVIATION NOV 2025)
52.219-8 (DEV) Utilization of Small Business Concerns (Jan 2025) (DEVIATION DEC 2025) 52.219-28 (DEV) Postaward Small Business Program Rerepresentation (Jan 2025)
(DEVIATION DEC 2025)
52.222-3 (DEV) Convict Labor (June 2003) (DEVIATION DEC 2025) 52.222-19 (DEV) Child Labor-Cooperation with Authorities and Remedies (Jan 2025)
(DEVIATION MAR 2026)
52.222-35 (DEV) Equal Opportunity for Veterans (Jun 2020) (DEVIATION DEC 2025) 52.222-36 (DEV) Equal Opportunity for Workers with Disabilities (Jun 2020) (DEVIATION
DEC 2025)
52.222-37 (DEV) Employment Reports on Veterans (Jun 2020) (DEVIATION DEC 2025) 52.222-41 (DEV) Service Contract Labor Standards (Aug 2018) (DEVIATION DEC 2025) 52.222-50 (DEV) Combating Trafficking in Persons (Oct 2025) (DEVIATION DEC 2025) 52.222-54 (DEV) Employment Eligibility Verification (Jan 2025) (DEVIATION DEC 2025) 52.224-3 Privacy Training (Jan 2017) 52.232-33 Payment by Electronic Funds Transfer-System for Award Management (Oct 2018) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.233-3 (DEV) Protest after Award (Aug 1996) (DEVIATION NOV 2025) 52.233-4 (DEV) Applicable Law for Breach of Contract Claim (Oct 2004) (DEVIATION NOV 2025) 52.240-91 (DEV) Security Prohibitions and Exclusions (DEVIATION NOV 2025) 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 (DEV) Computer Generated Forms (Jan 1991) (DEVIATION NOV 2025) 52.209-9 (DEV) Updates of Publicly Available Information Regarding Responsibility Matters (Oct 2018) (DEVIATION NOV 2025) 52.209-10 (DEV) Prohibition on Contracting With Inverted Domestic Corporations (Nov 2015)
(DEVIATION NOV 2025)
52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.222-90 Addressing DEI Discrimination by Federal Contractors (APR 2026) 52.237-7 (DEV) Indemnification and Medical Liability Insurance (Jan 1997) (DEVIATION NOV 2025) 52.240-93 (DEV) Basic Safeguarding of Covered Contractor Information Systems
(DEVIATION NOV 2025)
BOP 2852.201-71 Contracting Officer's Representative (COR) (June 2012)
15BCTS25Q00000014/0002 Page 3 of 52
BOP DOJ-05 DEVIATION BOP-05 Security of Department Information and Systems (January 2025) 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
52.203-11 Certification And Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2024) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-7 (DEV) System for Award Management-Registration (Nov 2024) (DEVIATION NOV 2025) 52.212-1 (DEV) Instructions to Offerors-Commercial Products and Commercial Services (Sep
2023) (DEVIATION NOV 2025)
52.212-2 (DEV) Evaluation-Commercial Products and Commercial Services (Nov 2021)
(DEVIATION NOV 2025)
52.217-5 (DEV) Evaluation of Options (July 1990) (DEVIATION AUG 2025) 52.219-4 (DEV) Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Oct 2022) (DEVIATION DEC 2025) 52.229-11 (DEV) Tax on Certain Foreign Procurements--Notice and Representation (Jun
2020) (DEVIATION AUG 2025)
52.216-1 (DEV) Type of Contract (Apr 1984) (DEVIATION DEC 2025) 52.240-90 (DEV) Security Prohibitions and Exclusions Representations and Certifications
(DEVIATION NOV 2025)
2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020)
15BCTS25Q00000014/0002 Page 4 of 52
Section 1 - Commodity or Services Schedule
MH/SU/SOT in Wichita, KS
Firm Fixed Price
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0001 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
3 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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
120 Units Guaranteed Minimum; 1200 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS25Q00000014/0002 Page 5 of 52
0005 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
90 Units Guaranteed Minimum; 2700 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
2,700
Change: 0
Current :
2,700
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
3 Units Guaranteed Minimum; 40 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 6 of 52
0010 Mental Health Intake Assessment & Report (5011)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 65 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 65
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 12 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 12
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Individual Counseling (6010)
40 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 7 of 52
0015 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 120 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 25
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; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current : 25
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
Previous :
Change: 0
Current : 15
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Sex Offender Individual Counseling (6012)
2 Units Guaranteed Minimum; 360 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 8 of 52
0020 Sex Offender Group Counseling (6022)
2 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Disorder Intake Screening (2005)
3 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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Substance Use Disorder Individual Counseling (2010)
120 Units Guaranteed Minimum; 1200 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 9 of 52
0025 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Substance Use Disorder Group Counseling (2020)
90 Units Guaranteed Minimum; 2700 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
2,700
Change: 0
Current :
2,700
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Mental Health Treatment Planning and Follow-up (5001)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0029 Mental Health Intake Screening (5005)
3 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
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 10 of 52
0030 Mental Health Intake Assessment & Report (5011)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 65 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 65
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 12 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 12
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 Mental Health Individual Counseling (6010)
40 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 11 of 52
0035 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 120 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 25
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; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
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
Previous :
Change: 0
Current : 15
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Sex Offender Individual Counseling (6012)
2 Units Guaranteed Minimum; 360 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 12 of 52
0040 Sex Offender Group Counseling (6022)
2 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Substance Use Disorder Intake Screening (2005)
3 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
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Substance Use Disorder Individual Counseling (2010)
120 Units Guaranteed Minimum; 1200 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 13 of 52
0045 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Substance Use Disorder Group Counseling (2020)
90 Units Guaranteed Minimum; 2700 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
2,700
Change: 0
Current :
2,700
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Mental Health Treatment Planning and Follow-up (5001)
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
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Mental Health Intake Screening (5005)
3 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
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 14 of 52
0050 Mental Health Intake Assessment & Report (5011)
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
PSC: G004
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 65 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 65
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 12 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 12
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Mental Health Individual Counseling (6010)
40 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 15 of 52
0055 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 120 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 25
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; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 25
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
PSC: G004
Previous :
Change: 0
Current : 15
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Sex Offender Individual Counseling (6012)
2 Units Guaranteed Minimum; 360 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 16 of 52
0060 Sex Offender Group Counseling (6022)
2 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Substance Use Disorder Intake Screening (2005)
3 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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Substance Use Disorder Individual Counseling (2010)
120 Units Guaranteed Minimum; 1200 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 17 of 52
0065 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Substance Use Disorder Group Counseling (2020)
90 Units Guaranteed Minimum; 2700 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
2,700
Change: 0
Current :
2,700
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Mental Health Treatment Planning and Follow-up (5001)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Mental Health Intake Screening (5005)
3 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
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 18 of 52
0070 Mental Health Intake Assessment & Report (5011)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 65 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 65
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 12 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 12
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Mental Health Individual Counseling (6010)
40 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 19 of 52
0075 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 120 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current : 25
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; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
Previous :
Change: 0
Current : 25
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
Previous :
Change: 0
Current : 15
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Sex Offender Individual Counseling (6012)
2 Units Guaranteed Minimum; 360 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 20 of 52
0080 Sex Offender Group Counseling (6022)
2 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Substance Use Disorder Intake Screening (2005)
3 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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Substance Use Disorder Individual Counseling (2010)
120 Units Guaranteed Minimum; 1200 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
1,200
Change: 0
Current :
1,200
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 75
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 21 of 52
0085 Co-occurring Intake Assessment & Report (2012)
2 Units Guaranteed Minimum; 35 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 35
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Substance Use Disorder Group Counseling (2020)
90 Units Guaranteed Minimum; 2700 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
2,700
Change: 0
Current :
2,700
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Mental Health Treatment Planning and Follow-up (5001)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Mental Health Intake Screening (5005)
3 Units Guaranteed Minimum; 40 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 40
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 22 of 52
0090 Mental Health Intake Assessment & Report (5011)
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
Previous :
Change: 0
Current : 50
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 65 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 65
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0092 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 12 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 12
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Mental Health Individual Counseling (6010)
40 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 36 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 36
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 23 of 52
0095 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 120 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
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; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current : 25
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
Previous :
Change: 0
Current : 15
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Sex Offender Individual Counseling (6012)
2 Units Guaranteed Minimum; 360 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 months through 60 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000014/0002 Page 24 of 52
0100 Sex Offender Group Counseling (6022)
2 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
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 Units Guaranteed Minimum; 38 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 38
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Substance Use Disorder Individual Counseling (2010)
60 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 Substance Use Disorder Intake Assessment & Report (2011)
5 Units Guaranteed Minimum; 38 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 38
EA $________ $_________________
15BCTS25Q00000014/0002 Page 25 of 52
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 Co-occurring Intake Assessment & Report (2012)
1 Units Guaranteed Minimum; 18 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 18
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 Substance Use Disorder Group Counseling (2020)
45 Units Guaranteed Minimum; 1350 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
1,350
Change: 0
Current :
1,350
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Substance Use Disorder Relationship and Parenting Counseling (2030)
1 Units Guaranteed Minimum; 18 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL 6 MONTH EXTENSION (EXT): 61 months thru 66 months
PSC: G004
Previous :
Change: 0
Current : 18
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Mental Health Treatment Planning and Follow-up (5001)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 20 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 20
15BCTS25Q00000014/0002 Page 26 of 52
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Mental Health Intake Assessment & Report (5011)
3 Units Guaranteed Minimum; 25 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 25
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Psychiatric Evaluation & Report (5030)
3 Units Guaranteed Minimum; 33 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 33
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Crisis Intervention Evaluation & Report (6000)
1 Unit Guaranteed Minimum; 6 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous : 6
Change: 0
Current : 6
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Mental Health Individual Counseling (6010)
20 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current :
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Mental Health Relationship and Parenting Counseling (6031)
1 Units Guaranteed Minimum; 18 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 18
15BCTS25Q00000014/0002 Page 27 of 52
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 MH- Medication Monitoring & Reporting (6051)
3 Units Guaranteed Minimum; 60 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 60
EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Sex Offender Intake Assessment & Report (5012)
1 Unit Guaranteed Minimum; 13 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL SIX MONTH EXTENSION (EXT): 61 months through 66 months
PSC: G004
Previous :
Change: 0
Current : 13
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; 13 Units Estimated Maximum Use the Estimated Maximum Quantity when developing the total amount.
POTENTIAL 6 MONTH EXTENSION (EXT): 61 mths through 66 mths
PSC: G004
Previous :
Change: 0
Current : 13
EA $________ $_________________
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 SIX MONTH EXTENSION (EXT): 61 months through 66 months
P…
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