15BCTS25Q00000016.pdf
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- Attached to
- SU MH in Great Falls, MT
- Solicitation number
- 15BCTS25Q00000016
About this file
This is a Solicitation/Contract/Order for Commercial Products and Commercial Services (SF-1449) issued by the Federal Bureau of Prisons (BOP) Community Treatment Services Contracting office seeking substance use and mental health treatment services in Great Falls, Montana.
The solicitation (Number 15BCTS25Q00000016) is a 100% small business set-aside for a Firm Fixed Price Indefinite Delivery Indefinite Quantity (IDIQ) contract. The offer due date is September 3, 2026, at 14:00 ET, with a delivery date of October 1, 2026. The contract employs a best value evaluation approach considering technical capability and lowest price technically available. The NAICS code is 621420 with a $19,000,000 size standard. The contract includes a 12-month base period followed by four one-year options and a potential six-month extension, for a maximum five-year performance period. Payment will be made by the BOP North Central Regional Office in Kansas City, Kansas. The schedule consists of 91 line items across both the base and option periods, with estimated quantities and unit prices to be provided by offerors. Line items include substance use disorder services (treatment planning, intake screening, individual and group counseling, assessments) and mental health services (treatment planning, intake screening, assessments, psychiatric evaluations, crisis intervention, individual and relationship counseling, and medication monitoring), with quantities ranging from guaranteed minimums to estimated maximums. Offerors must submit a completed Standard Form 1449, Business Quotation Information Packet, Technical Quotation Information Packet, Attachment Quotation Form, Pricing Chart, proof of active SAM registration, current Professional Liability Insurance, and ATU Vendor Attestation Form via email to sjones2@bop.gov. The contract incorporates extensive FAR clauses and DOJ-specific requirements including personnel security clearances (Public Trust Investigation), privacy and data protection protocols, cybersecurity safeguards, and contractor employee reporting obligations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Questions 15BCTS25Q00000016 CTS in Great Falls MT.pdf | ||
| Cover Letter Great Falls MT.pdf | ||
| 2022 STATEMENT OF WORK (SOW).pdf | ||
| ATU Vendor Attestation.pdf | ||
| Whistleblower Information.pdf | ||
| Technical Quotation Packet.docx | DOCX document | |
| Business Quotation Information Packet.pdf | ||
| Quotation Attachment Form.xlsx | XLSX spreadsheet | |
| Pricing Chart.pdf | ||
| Combined Synopsis Solicitation Great Falls MT.pdf |
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15BCTS25Q00000016 Page 1 of 53
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
15BCTS25Q00000016
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
08/03/2026
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Shuwona Jones sjones2@bop.gov
b. TELEPHONE NUMBER (No collect calls)
202-598-6128
8. OFFER DUE DATE / LOCAL
TIME
09/03/2026 14:00 ET
CODE 15BCTS
Federal Bureau of Prisons
Community Treatment Services Contracting 320 First Street NW
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 Washington, DC 20534
Shuwona Jones
(O) 202-598-6128 sjones2@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: 10/01/2026
Substance Use and Mental Health Treatment Services in Great Falls, MT.
Firm Fixed Price
See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)
X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3
AND 52.212-5 ARE ATTACHED. ADDENDA
ARE X ARE NOT ATTACHED
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED
X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO
ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH
OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE
TERMS AND CONDITIONS SPECIFIED.
29. AWARD OF CONTRACT: REFERENCE _____________________________
OFFER DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK
5) INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH
HEREIN, IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)
30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (Type or print)
Shuwona Jones
31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 11/2021)
Prescribed by GSA - FAR (48 CFR) 53.212
Federal Bureau of Prisons North Central Regional Office
400 STATE AVENUE SUITE 800
Kansas City, KS 66101
15BCTS25Q00000016 Page 2 of 53
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
15BCTS25Q00000016 Page 3 of 53
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) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-13 Alt I (DEV) System for Award Management-Maintenance (Oct 2018) - Alternate I
(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) 52.224-1 Privacy Act Notification (Apr 1984)
15BCTS25Q00000016 Page 4 of 53
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) 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)
15BCTS25Q00000016 Page 5 of 53
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)
10 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
0002 Substance Use Disorder Intake Screening (2005)
2 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
40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
10 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
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
10 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
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
35 EA $________ $_________________
15BCTS25Q00000016 Page 6 of 53
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 3600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 Mental Health Treatment Planning and Follow-up (5001)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 Mental Health Intake Screening (5005)
2 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
0010 Mental Health Intake Assessment & Report (5011)
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
75 EA $________ $_________________
15BCTS25Q00000016 Page 7 of 53
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Psychiatric Evaluation & Report (5030)
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
75 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)
120 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; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 MH- Medication Monitoring & Reporting (6051)
10 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Base Period: 1 month through 12 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS25Q00000016 Page 8 of 53
0016 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 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
0017 Substance Use Disorder Intake Screening (2005)
2 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
0018 Substance Use Disorder Individual Counseling (2010)
10 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
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 Substance Use Disorder Intake Assessment & Report (2011)
10 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
0020 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
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 3600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
3,600 EA $________ $_________________
15BCTS25Q00000016 Page 9 of 53
Option Year 1: 13 months through 24 months
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Mental Health Treatment Planning and Follow-up (5001)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Mental Health Intake Screening (5005)
2 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
0025 Mental Health Intake Assessment & Report (5011)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Psychiatric Evaluation & Report (5030)
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
15BCTS25Q00000016 Page 10 of 53
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 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
0028 Mental Health Individual Counseling (6010)
120 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
0029 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 MH- Medication Monitoring & Reporting (6051)
10 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 1: 13 months through 24 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 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.
15BCTS25Q00000016 Page 11 of 53
0032 Substance Use Disorder Intake Screening (2005)
2 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
0033 Substance Use Disorder Individual Counseling (2010)
10 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
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0034 Substance Use Disorder Intake Assessment & Report (2011)
10 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
0035 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
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 3600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total
48 EA $________ $_________________
15BCTS25Q00000016 Page 12 of 53
Option Year 2: 25 months through 36 months
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Mental Health Treatment Planning and Follow-up (5001)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Mental Health Intake Screening (5005)
2 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
50 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Mental Health Intake Assessment & Report (5011)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Psychiatric Evaluation & Report (5030)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 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
10 EA $________ $_________________
15BCTS25Q00000016 Page 13 of 53
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 Mental Health Individual Counseling (6010)
120 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 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 MH- Medication Monitoring & Reporting (6051)
10 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 2: 25 months through 36 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Substance Use Disorder Treatment Planning and Follow-up (2001)
10 Units Guaranteed Minimum; 60 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Substance Use Disorder Intake Screening (2005)
2 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.
15BCTS25Q00000016 Page 14 of 53
0048 Substance Use Disorder Individual Counseling (2010)
10 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
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 60 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 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
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 3600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Mental Health Treatment Planning and Follow-up (5001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total
15BCTS25Q00000016 Page 15 of 53
Option Year 3: 37 months through 48 months
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Mental Health Intake Screening (5005)
2 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
0055 Mental Health Intake Assessment & Report (5011)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 Psychiatric Evaluation & Report (5030)
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
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 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
0058 Mental Health Individual Counseling (6010)
120 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
1,800 EA $________ $_________________
15BCTS25Q00000016 Page 16 of 53
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Mental Health Relationship and Parenting Counseling (6031)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 MH- Medication Monitoring & Reporting (6051)
10 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 3: 37 months through 48 months
PSC: G004
300 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; 60 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Substance Use Disorder Intake Screening (2005)
2 Units Guaranteed Minimum; 40 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
40 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0063 Substance Use Disorder Individual Counseling (2010)
10 Units Guaranteed Minimum; 600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS25Q00000016 Page 17 of 53
0064 Substance Use Disorder Intake Assessment & Report (2011)
10 Units Guaranteed Minimum; 60 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
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 4: 49 - 60 months
PSC: G004
35 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Substance Use Disorder Group Counseling (2020)
120 Units Guaranteed Minimum; 3600 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
3,600 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 Substance Use Disorder Relationship and Parenting Counseling (2030)
2 Units Guaranteed Minimum; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
48 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Mental Health Treatment Planning and Follow-up (5001)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Mental Health Intake Screening (5005)
2 Units Guaranteed Minimum; 50 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total
50 EA $________ $_________________
15BCTS25Q00000016 Page 18 of 53
Option Year 4: 49 - 60 months
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Mental Health Intake Assessment & Report (5011)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
75 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Psychiatric Evaluation & Report (5030)
10 Units Guaranteed Minimum; 75 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
75 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 4: 49 - 60 months
PSC: G004
10 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Mental Health Individual Counseling (6010)
120 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 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; 48 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
48 EA $________ $_________________
15BCTS25Q00000016 Page 19 of 53
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 MH- Medication Monitoring & Reporting (6051)
10 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Option Year 4: 49 - 60 months
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Substance Use Disorder Treatment Planning and Follow-up (2001)
5 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
0077 Substance Use Disorder Intake Screening (2005)
1 Unit 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
0078 Substance Use Disorder Individual Counseling (2010)
5 Units Guaranteed Minimum; 300 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
300 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Substance Use Disorder Intake Assessment & Report (2011)
5 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.
15BCTS25Q00000016 Page 20 of 53
0080 Co-occurring Intake Assessment & Report (2012)
1 Unit Guaranteed Minimum; 18 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
18 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 Substance Use Disorder Group Counseling (2020)
60 Units Guaranteed Minimum; 1800 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
1,800 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 Substance Use Disorder Relationship and Parenting Counseling (2030)
1 Unit Guaranteed Minimum; 24 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Mental Health Treatment Planning and Follow-up (5001)
5 Units Guaranteed Minimum; 38 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
38 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Mental Health Intake Screening (5005)
1 Unit 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
0085 Mental Health Intake Assessment & Report (5011)
5 Units Guaranteed Minimum; 38 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total
38 EA $________ $_________________
15BCTS25Q00000016 Page 21 of 53
Potential 6 Month Extension
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Psychiatric Evaluation & Report (5030)
5 Units Guaranteed Minimum; 38 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
38 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0087 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
0088 Mental Health Individual Counseling (6010)
60 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
0089 Mental Health Relationship and Parenting Counseling (6031)
1 Unit Guaranteed Minimum; 24 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
PSC: G004
24 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 MH- Medication Monitoring & Reporting (6051)
5 Units Guaranteed Minimum; 150 Units Estimated Maximum
Use the Estimated Maximum Quantity when developing the total amount.
Potential 6 Month Extension
150 EA $________ $_________________
15BCTS25Q00000016 Page 22 of 53
Section 2 - Contract Clauses
A.1 ADDENDUM TO FAR 52.212-4, Terms and Conditions-Commercial Products and Commercial Services (Nov
2023) (DEVIATION NOV 2025)
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)
52.203-6 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)
15BCTS25Q00000016 Page 23 of 53
Clause Title Fill-ins (if applicable)
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)
15BCTS25Q00000016 Page 24 of 53
Clauses By Full Text
52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020)
(a) Definitions. As used in this clause--
"Agency" means "executive agency" as defined in Federal Acquisition Regulation (FAR) 2.101.
"Covered Federal action" means any of the following actions:
(1) Awarding any Federal contract.
(2) Making any Federal grant.
(3) Making any Federal loan.
(4) Entering into any cooperative agreement.
(5) Extending, continuing, renewing, amending, or modifying any Federal contract, grant, loan, or cooperative agreement.
"Indian tribe" and "tribal organization" have the meaning provided in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b) and include Alaskan Natives.
"Influencing or attempting to influence" means making, with the intent to influence, any communication to or appearance before an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any covered Federal action.
"Local government" means a unit of government in a State and, if chartered, established, or otherwise recognized by a State for the performance of a governmental duty, including a local public authority, a special district, an intrastate district, a council of governments, a sponsor group representative organization, and any other instrumentality of a local government.
"Officer or employee of an agency" includes the following individuals who are employed by an agency:
(1) An individual who is appointed to a position in the Government under Title 5, United States Code, including a position under a temporary appointment.
(2) A member of the uniformed services, as defined in subsection 101(3), Title 37, United States Code.
(3) A special Government employee, as defined in section 202, Title 18, United States Code.
(4) An individual who is a member of a Federal advisory committee, as defined by the Federal Advisory Committee Act, Title 5, United States Code, appendix 2.
"Person" means an individual, corporation, company, association, authority, firm, partnership, society, State, and local government, regardless of whether such entity is operated for profit, or not for profit. This term excludes an Indian tribe, tribal organization, or any other Indian organization eligible to receive Federal contracts, grants, cooperative agreements, or loans from an agency, but only with respect to expenditures by such tribe or organization that are made for purposes specified in paragraph (b) of this clause and are permitted by other Federal law.
"Reasonable compensation" means, with respect to a regularly employed officer or employee of any person, compensation that is consistent with the normal compensation for such officer or employee for work that is not furnished to, not funded by, or not furnished in cooperation with the Federal Government.
"Reasonable payment" means, with respect to professional and other technical services, a payment in an amount that is consistent with the amount normally paid for such services in the private sector.
"Recipient" includes the Contractor and all subcontractors. This term excludes an Indian tribe, tribal organization, or any other Indian organization eligible to receive Federal contracts, grants, cooperative agreements, or loans from an agency, 15BCTS25Q00000016 Page 25 of 53 but only with respect to expenditures by such tribe or organization that are made for purposes specified in paragraph (b) of this clause and are permitted by other Federal law.
"Regularly employed" means, with respect to an officer or employee of a person requesting or receiving a Federal contract, an officer or employee who is employed by such person for at least 130 working days within 1 year immediately preceding the date of the submission that initiates agency consideration of such person for receipt of such contract. An officer or employee who is employed by such person for less than 130 working days within 1 year immediately preceding the date of the submission that initiates agency consideration of such person shall be considered to be regularly employed as soon as he or she is employed by such person for 130 working days.
"State" means a State of the United States, the District of Columbia, or an outlying area of the United States, an agency or instrumentality of a State, and multi-State, regional, or interstate entity having governmental duties and powers.
(b) Prohibition. 31 U.S.C. 1352 prohibits a recipient of a Federal contract, grant, loan, or cooperative agreement from using appropriated funds to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any covered Federal actions. In accordance with 31 U.S.C. 1352 the Contractor shall not use appropriated funds to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the award of this contractor the extension, continuation, renewal, amendment, or modification of this contract.
(1) The term appropriated funds does not include profit or fee from a covered Federal action.
(2) To the extent the Contractor can demonstrate that the Contractor has sufficient monies, other than Federal appropriated funds, the Government will assume that these other monies were spent for any influencing activities that would be unallowable if paid for with Federal appropriated funds.
(c) Exceptions. The prohibition in paragraph (b) of this clause does not apply under the following conditions:
(1) Agency and legislative liaison by Contractor employees. (i) Payment of reasonable compensation made to an officer or employee of the Contractor if the payment is for agency and legislative liaison activities not directly related to this contract.
For purposes of this paragraph, providing any information specifically requested by an agency or Congress is permitted at any time.
(ii) Participating with an agency in discussions that are not related to a specific solicitation for any covered Federal action, but that concern--
(A) The qualities and characteristics (including individual demonstrations) of the person's products or services, conditions or terms of sale, and service capabilities; or
(B) The application or adaptation of the person's products or services for an agency's use.
(iii) Providing prior to formal solicitation of any covered Federal action any information not specifically requested but necessary for an agency to make an informed decision about initiation of a covered Federal action;
(iv) Participating in technical discussions regarding the preparation of an unsolicited proposal prior to its official submission; and
(v) Making capability presentations prior to formal solicitation of any covered Federal action by persons seeking awards from an agency pursuant to the provisions of the Small Business Act, as amended by Pub. L. 95-507, and subsequent amendments.
(2) Professional and technical services. (i) A payment of reasonable compensation made to an officer or employee of a person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action, if payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action.
(ii) Any reasonable payment to a person, other than an officer or employee of a person requesting or receiving a covered Federal action or an extension, continuation, renewal, amendment, or modification of a covered Federal action if the
15BCTS25Q00000016 Page 26 of 53 payment is for professional or technical services rendered directly in the preparation, submission, or negotiation of any bid, proposal, or application for that Federal action or for meeting requirements imposed by or pursuant to law as a condition for receiving that Federal action. Persons other than officers or employees of a person requesting or receiving a covered Federal action include consultants and trade associations.
(iii) As used in paragraph (c)(2) of this clause, "professional and technical services" are limited to advice and analysis directly applying any professional or technical discipline (for examples, see FAR 3.803(a)(2)(iii)).
(iv) Requirements imposed by or pursuant to law as a condition for receiving a covered Federal award include those required by law or regulation and any other requirements in the actual award documents.
(3) Only those communications and services expressly authorized by paragraphs (c)(1) and (2) of this clause are permitted.
(d)…
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