15BCTS25R00000003_Cover Letter included_Baltimore MD.pdf

U. S. Department of Justice

Federal Bureau of Prisons

Washington, D.C. 20534

January 13, 2025

Re: RFP 15BCTS25R00000003, Baltimore, MD

All Interested Parties:

This Request for Proposal (RFP) is to provide community-based outpatient Substance Abuse, Mental Health, and Sex Offender treatment services for male and female Adults in Custody (AICs) residing in a Residential Reentry Center (RRC), on home confinement, or on Federal Location Monitoring or, if applicable, reporting to a Day Reporting Center, in Baltimore, MD area.

Services are to be provided in accordance with the enclosed Statement of Work entitled, “Community Treatment Services (CTS), 2022 Statement of Work (SOW).”

Services are needed within a ten (10) miles radius of the Baltimore Federal Courthouse, 101 W. Lombard Street, Baltimore, MD 21201, and within a half (0.5) mile access to public transportation. This requirement will ensure the contractor is located within walking distance of public transportation, offenders are not subject to walking long distances in inclement weather, and AICs accountability is maintained.

The following must be completed and submitted with your proposal:

Standard Form (SF) 1449 - Solicitation/Contract/Order for Commercial Items - Please completes blocks 12, 17a, 17b, 23, 24, 30a, 30b, and 30c, of the SF-1449, the continuation sheets and appropriate attachments. Please include your telephone number in Block 17a. Original signatures are required.

Representations and Certifications (FAR 52.212-3) Prospective offerors are required to submit Annual Representations and Certifications at https://www.sam.gov/portal/public/SAM/. By submission of a proposal under this solicitation, the offerors acknowledges completion of the annual representations and certifications and verifies, by the submission of the proposal, that the http://www.sam.gov/portal/public/SAM/ bop31773 Highlight representations and certifications currently posted in SAM.gov were entered or updated within the last 12 months and are current, accurate, complete, and applicable to this solicitation.

All offerors must be capable of and comply with FAR 52.212-1(j), Instructions to Offerors - Commercial Products and Commercial Services (Sep 2023) 52.204-6, Unique Entity Identifier (Oct 2016) and 52.204-7, System for Award Management (SAM)(Nov 2024).

Required Documentation Identified at Addendum to 52.212-1 Instructions to Offerors — Commercial Products and Commercial Services (Sep 2023)

The Government shall award to the lowest priced, technically acceptable (LPTA), responsive and responsible offeror.

Offers will only be accepted via email to cmagee@bop.gov.

Please include SEPARATE FILE ATTACHMENTS for the following:

• Completed SF-1449(Including the pricing table at section 2.1)

• Completed Business Proposal Information Packet

• Completed Technical Proposal Information Packet

• Proof of completed SAM registration (must be active by time

• of proposal submission)

• A copy of your current Professional Liability Insurance

• Completed Attachment Proposal Form

Proposals shall be emailed by February 10, 2025, 12:00 P.M.

(EST) to cmagee@bop.gov. Please confirm that all emails and attachments were received.

The solicitation will be distributed solely through the General Services Administration’s www.sam.gov website. Hard copies of the solicitation document will not be available. The website provides downloading instructions.

mailto:cmagee@bop.gov mailto:cmagee@bop.gov.

http://www.sam.gov/

All future information about this solicitation, including solicitation amendments, will also be solely distributed through this website. Interested parties are responsible for monitoring this website to ensure they have the most up-to-date information about this solicitation.

Please direct any questions to cmagee@bop.gov. Please ensure to have the Notice ID in the Subject line of all email correspondence.

Regards, Coretta MaGee Contracting Officer mailto:cmagee@bop.gov

15BCTS25R00000003 Page 1 of 81

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

15BCTS25R00000003

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

01/13/2025

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Coretta MaGee cmagee@bop.gov

b. TELEPHONE NUMBER (No collect calls)

202-598-6114

8. OFFER DUE DATE / LOCAL

TIME

02/10/2025 12:00 ET

CODE 15BCTS

Federal Bureau of Prisons

Community Treatment Services Contracting

320 First Street NW

Suite 901-5

Washington, DC 20534

9. ISSUED BY 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

REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

14. METHOD OF SOLICITATION

15B100CODE15. DELIVER TO CODE 15BCTS16. ADMINISTERED BY

Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534

Coretta MaGee

(O) 202-598-6114 cmagee@bop.gov

FACILITY

CODE

CODE

TELEPHONE NUMBER

17a. CONTRACTOR/

OFFEROR

15B100CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons Mid Atlantic Regional Office 302 Sentinel Drive Suite 200 Annapolis Junction, MD 20701

BOP-RSD-CRBCTS-BILL-DC-S@bop.gov

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Delivery Date: 04/01/2025

Outpatient Substance Use Disorder (SU), Mental Health (MH) & Sex Offender Treatment (SOT) Services in Baltimore, MD 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)

Coretta MaGee

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 Mid Atlantic Regional Office 302 Sentinel Drive Suite 200 Annapolis Junction, MD 20701

003-25

X bop31773 Highlight bop31773 Highlight bop31773 Highlight bop31773 Highlight bop31773 Highlight bop31773 Highlight

15BCTS25R00000003 Page 2 of 81

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

15BCTS25R00000003 Page 3 of 81

Table of Contents

Section Description Page Number

Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses

52.203-3 Gratuities (Apr 1984) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2023) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.242-13 Bankruptcy (July 1995) 52.242-15 Stop-Work Order (Aug 1989) 52.253-1 Computer Generated Forms (Jan 1991) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.202-1 Definitions (Jun 2020) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.226-8 Encouraging Contractor Policies To Ban Text Messaging While Driving (May 2024) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS

(APR 2011)

DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-02 Contractor Privacy Requirements (JAN 2022) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency (OCT 2007) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (May 2024) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Products and Commercial Services (Nov 2024) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021)...

52.217-9 Option to Extend the Term of the Contract (Mar 2000)

3 List of Attachments 4 Solicitation Provisions

52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-7 System for Award Management (Nov 2024) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Sep 2023) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.204-29 Federal Acquisition Supply Chain Security Act Orders-Representation and Disclosures (Dec 2023) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.216-1 Type of Contract (Apr 1984)

15BCTS25R00000003 Page 4 of 81

52.217-5 Evaluation of Options (July 1990) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (NOV 2020)

15BCTS25R00000003 Page 5 of 81

Section 1 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0001 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 160 Estimated Maximum Quantity: 1100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

100 EA $________ $_________________

15BCTS25R00000003 Page 6 of 81

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4950

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,950 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

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

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 125

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

125 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity:50 Estimated Maximum Quantity: 325

Base Period: Date of award - 12 months

325 EA $________ $_________________

15BCTS25R00000003 Page 7 of 81

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 12

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity:180 Estimated Maximum Quantity: 1200

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Mental Health Group Counseling (6020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4800

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 Case Management Services (6029)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 945

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

945 EA $________ $_________________

15BCTS25R00000003 Page 8 of 81

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 8

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 900

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Sex Offender Intake Assessment & Report (5012)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

95 EA $________ $_________________

15BCTS25R00000003 Page 9 of 81

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Sex Offender Intake Screening (6005)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Sex Offender Individual Counseling (6012)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 300

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

300 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Sex Offender Group Counseling (6022)

Guaranteed Minimum Quantity: 300 Estimated Maximum Quantity: 2100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Sex Offender Relationship and Parenting Counseling (6032)

Guaranteed Minimum; Quantity: 2 Estimated Maximum Quantity: 100

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

275 EA $________ $_________________

15BCTS25R00000003 Page 10 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 160 Estimated Maximum Quantity: 1100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4950

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

4,950 EA $________ $_________________

15BCTS25R00000003 Page 11 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 125

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

125 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity:50 Estimated Maximum Quantity: 325

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25R00000003 Page 12 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 12

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity:180 Estimated Maximum Quantity: 1200

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Mental Health Group Counseling (6020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4800

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Case Management Services (6029)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 945

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

945 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25R00000003 Page 13 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 8

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 900

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Sex Offender Intake Assessment & Report (5012)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Sex Offender Intake Screening (6005)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

40 EA $________ $_________________

15BCTS25R00000003 Page 14 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Sex Offender Individual Counseling (6012)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 300

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

300 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Sex Offender Group Counseling (6022)

Guaranteed Minimum Quantity: 300 Estimated Maximum Quantity: 2100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Sex Offender Relationship and Parenting Counseling (6032)

Guaranteed Minimum; Quantity: 2 Estimated Maximum Quantity: 100

Option Year 1: 13 - 24 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Sex Offender Relationship and Parenting Counseling (6032)

Guaranteed Minimum; Quantity: 2 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Sex Offender Group Counseling (6022)

Guaranteed Minimum Quantity: 300 Estimated Maximum Quantity: 2100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

2,100 EA $________ $_________________

15BCTS25R00000003 Page 15 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Sex Offender Individual Counseling (6012)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 300

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

300 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Sex Offender Intake Screening (6005)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Sex Offender Intake Assessment & Report (5012)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 900

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

900 EA $________ $_________________

15BCTS25R00000003 Page 16 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 8

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Case Management Services (6029)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 945

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

945 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Mental Health Group Counseling (6020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4800

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity:180 Estimated Maximum Quantity: 1200

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

1,200 EA $________ $_________________

15BCTS25R00000003 Page 17 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 12

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity:50 Estimated Maximum Quantity: 325

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 125

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

125 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25R00000003 Page 18 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4950

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,950 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 160 Estimated Maximum Quantity: 1100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

1,100 EA $________ $_________________

15BCTS25R00000003 Page 19 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 2: 25 - 36 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 160 Estimated Maximum Quantity: 1100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

1,100 EA $________ $_________________

15BCTS25R00000003 Page 20 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4950

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,950 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25R00000003 Page 21 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 125

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

125 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity:50 Estimated Maximum Quantity: 325

Base Period: Date of award - 12 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 12

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity:180 Estimated Maximum Quantity: 1200

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

1,200 EA $________ $_________________

15BCTS25R00000003 Page 22 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Mental Health Group Counseling (6020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4800

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Case Management Services (6029)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 945

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

945 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 8

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 900

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

900 EA $________ $_________________

15BCTS25R00000003 Page 23 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Sex Offender Intake Assessment & Report (5012)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Sex Offender Intake Screening (6005)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Sex Offender Individual Counseling (6012)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 300

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

300 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 Sex Offender Group Counseling (6022)

Guaranteed Minimum Quantity: 300 Estimated Maximum Quantity: 2100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

2,100 EA $________ $_________________

15BCTS25R00000003 Page 24 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 Sex Offender Relationship and Parenting Counseling (6032)

Guaranteed Minimum; Quantity: 2 Estimated Maximum Quantity: 100

Option Year 3: 37 - 48 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0097 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

275 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Substance Use Disorder Intake Screening (2005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 Substance Use Disorder Individual Counseling (2010)

Guaranteed Minimum; Quantity: 160 Estimated Maximum Quantity: 1100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0100 Substance Use Disorder Intake Assessment & Report (2011)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 275

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

275 EA $________ $_________________

15BCTS25R00000003 Page 25 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Co-occurring Intake Assessment & Report (2012)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Substance Use Disorder Group Counseling (2020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4950

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

4,950 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Substance Use Disorder Relationship and Parenting Counseling (2030)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 Mental Health Treatment Planning and Follow-up (5001)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Mental Health Intake Screening (5005)

Guaranteed Minimum Quantity: 25 Estimated Maximum Quantity: 125

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

125 EA $________ $_________________

15BCTS25R00000003 Page 26 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Mental Health Intake Assessment & Report (5011)

Guaranteed Minimum Quantity:50 Estimated Maximum Quantity: 325

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Psychiatric Evaluation & Report (5030)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 325

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

325 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0108 Crisis Intervention Evaluation & Report (6000)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 12

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 Mental Health Individual Counseling (6010)

Guaranteed Minimum Quantity:180 Estimated Maximum Quantity: 1200

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 Mental Health Group Counseling (6020)

Guaranteed Minimum Quantity: 600 Estimated Maximum Quantity: 4800

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

4,800 EA $________ $_________________

15BCTS25R00000003 Page 27 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Case Management Services (6029)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 945

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

945 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Mental Health Relationship and Parenting Counseling (6031)

Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0113 MH - Administration of Medication (6050)

Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 8

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 MH - Medication Monitoring & Report (6051)

Guaranteed Minimum Quantity: 50 Estimated Maximum Quantity: 900

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Sex Offender Intake Assessment & Report (5012)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

95 EA $________ $_________________

15BCTS25R00000003 Page 28 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

Guaranteed Minimum Quantity: 15 Estimated Maximum Quantity: 95

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

95 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Sex Offender Intake Screening (6005)

Guaranteed Minimum Quantity: 10 Estimated Maximum Quantity: 40

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Sex Offender Individual Counseling (6012)

Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 300

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

300 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 Sex Offender Group Counseling (6022)

Guaranteed Minimum Quantity: 300 Estimated Maximum Quantity: 2100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

PSC: G004

2,100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0120 Sex Offender Relationship and Parenting Counseling (6032)

Guaranteed Minimum; Quantity: 2 Estimated Maximum Quantity: 100

Option Year 4: 49 - 60 months

Use the Estimated Maximum Quantity when developing the total amount.

15BCTS25R00000003 Page 29 of 81

QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Substance Use Disorder Treatment Planning and Follow-up (2001)

Guaranteed…