9. 15BCTS23Q00000002.pdf

15BCTS23Q00000002 Page 1 of 68

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER PAGE 1 OF

5. SOLICITATION NUMBER

15BCTS23Q00000002

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Jerald Lynch jalynch@bop.gov

b. TELEPHONE NUMBER (No collect calls)

(202) 598-6129

8. OFFER DUE DATE / LOCAL

TIME

02/28/2023 14:00 ET

CODE BCTS

Federal Bureau of Prisons Acquisitions Branch/Community Treatment Svcs Contractng 320 First Street NW Room 901-5 Washington, DC 20534

9. ISSUED BY UNRESTRICTED OR X SET ASIDE: % FOR

X SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS: 621420

SIZE STANDARD: $19,000,000

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

X RFQ IFB RFP

14. METHOD OF SOLICITATION

15B200CODE15. DELIVER TO

Federal Bureau of Prisons Northeast Regional Office

US CUSTOM HOUSE, 7TH FLOOR

2ND & CHESTNUT

Philadelphia, PA 19106

CODE 15BCTS16. ADMINISTERED BY

Federal Bureau of Prisons Community Treatment Svcs Contractng 320 First Street NW Room 901-5 Washington, DC 20534

Jerald Lynch

(O) (202) 598-6129 jalynch@bop.gov

FACILITY

CODE

CODE

TELEPHONE NO.

17a. CONTRACTOR/

OFFEROR

15B200CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons Northeast Regional Office

US CUSTOM HOUSE, 7TH FLOOR

2ND & CHESTNUT

Philadelphia, PA 19106

BOP-RSD-CRBCTS-BILL-PHL@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 NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Delivery Date: 06/01/2023

Substance Use, Mental Health, Medication Assistance and Sex Offender Treatment Services in Brooklyn- Manhattan, NY.

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 Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE 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: REF. _____________________________ 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)

Jerald Lynch

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212 bop06593 Typewritten Text 002-23

15BCTS23Q00000002 Page 2 of 68

19.

ITEM NO.

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. 2/2012) BACK

15BCTS23Q00000002 Page 3 of 68

Table of Contents

Section Description Page Number

1 Solicitation/Contract Form 2 Commodity or Services Schedule 3 Contract Clauses

52.242-15 Stop-Work Order (Aug 1989) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) DOJ-05 Security of Department Information and Systems (APR 2015) 52.203-3 Gratuities (Apr 1984) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Dec 2013) 52.253-1 Computer Generated Forms (Jan 1991) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Nov 2021) 52.203-12 Limitation On Payments To Influence Certain Federal Transactions (Oct 2010) 52.242-13 Bankruptcy (July 1995) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.204-13 System for Award Management Maintenance (Oct 2018) 52.216-18 Ordering (Oct 1995) 52.216-19 Order Limitations (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.232-18 Availability Of Funds (Apr 1984) 52.232-19 Availability Of Funds For The Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR

2011) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (June 2016) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Oct 2022) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Oct 2022) DOJ-01 Whistleblower Information Distribution (Oct 2021) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021); (Alt. I) -- Classified Information -- Cleared Contractors 52.216-22 Indefinite Quantity (Oct 1995) DOJ-08 Continuing Contract Performance During a Pandemic Influenza or other National Emergency

(OCT 2007)

4 List of Attachments 5 Solicitation Provisions

52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Dec 2019) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Dec 2019) 52.204-16 Commercial and Government Entity Code Reporting (Jul 2016) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.204-7 System for Award Management (Oct 2018) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Nov 2021) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (Jan 1998) 52.216-1 Type of Contract (Apr 1984) 52.217-5 Evaluation of Options (July 1990)

15BCTS23Q00000002 Page 4 of 68

Section 2 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0001 Substance Use Intake Screening (2005) 4 Units Guaranteed Minimum; 50 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Individual Counseling (2010) 1800 Units Guaranteed Minimum; 11200 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Intake Assessment & Report (2011) 20 Units Guaranteed Minimum; 150 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Dual Diagnosis Intake Assessment & Report (2012) 4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Substance Use Group Counseling (2020) 2400 Units Guaranteed Minimum; 13500 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Family Counseling (2030) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

4 EA $________ $_________________

15BCTS23Q00000002 Page 5 of 68

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Buprenorphine Follow-Up and Report - MAT (4002) 8 Unit Guaranteed Minimum; 140 Units Estimated Maximum

Base Period: Date of Award to 12 Months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 Naltrexone Follow-Up and Report - MAT (4003) 4 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: Date of Award to 12 Months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 Administration of Naltrexone - MAT (4040) 2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Base Period: Date of Award to 12 Months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 Psychiatric Evaluation & Report - MAT (4050) 8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Intake Screening - Mental Health (5005) 4 Units Guaranteed Minimum; 55 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Intake Assessment & Report - Mental Health (5011) 30 Units Guaranteed Minimum; 120 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Psychiatric Evaluation & Report - Mental Health (5030) 30 Unit Guaranteed Minimum; 120 Units Estimated Maximum

30 EA $________ $_________________

15BCTS23Q00000002 Page 6 of 68

Base Period: Date of award - 12 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Crisis Intervention Evaluation & Report (6000) 4 Units Guaranteed Minimum; 25 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 Individual Counseling - Mental Health (6010) 320 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

320 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 Case Management Services - Mental Health (6030) 4 Units Guaranteed Minimum; 80 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Family Counseling - Mental Health (6031) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Administration of Medication - Mental Health (6050) 2 Units Guaranteed Minimum; 20 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Medication Monitoring and Report - Mental Health (6051) 20 Units Guaranteed Minimum; 350 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS23Q00000002 Page 7 of 68

0020 Specific Intake Assessment & Report - Sex Offender (5012) 4 Units Guaranteed Minimum; 30 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Intake Screening - Sex Offender (6005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Individual Counseling - Sex Offender (6012) 40 Units Guaranteed Minimum; 620 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Group Counseling - Sex Offender (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Family Counseling - Sex Offender (6032) 4 Units Guaranteed Minimum; 48 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Substance Use Intake Screening (2005) 4 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Individual Counseling (2010) 1800 Units Guaranteed Minimum; 11200 Units Estimated Maximum

Option Year 1: 13 months through 24 months

1,800 EA $________ $_________________

15BCTS23Q00000002 Page 8 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Substance Use Intake Assessment & Report (2011) 20 Units Guaranteed Minimum; 150 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Dual Diagnosis Intake Assessment & Report (2012) 4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Substance Use Group Counseling (2020) 2400 Units Guaranteed Minimum; 13500 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Substance Use Family Counseling (2030) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Buprenorphine Follow-Up and Report - MAT (4002) 8 Unit Guaranteed Minimum; 140 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Naltrexone Follow-Up and Report - MAT (4003) 4 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Administration of Naltrexone - MAT (4040) 2 Units Guaranteed Minimum; 60 Units Estimated Maximum

2 EA $________ $_________________

15BCTS23Q00000002 Page 9 of 68

Option Year 1: 13 months through 24 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Psychiatric Evaluation & Report - MAT (4050) 8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Intake Screening - Mental Health (5005) 4 Units Guaranteed Minimum; 55 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Intake Assessment & Report - Mental Health (5011) 30 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Psychiatric Evaluation & Report - Mental Health (5030) 30 Unit Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 Crisis Intervention Evaluation & Report (6000) 4 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Individual Counseling - Mental Health (6010) 320 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

320 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 10 of 68

0040 Case Management Services - Mental Health (6030) 4 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Family Counseling - Mental Health (6031) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 Administration of Medication - Mental Health (6050) 2 Units Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Medication Monitoring and Report - Mental Health (6051) 20 Units Guaranteed Minimum; 350 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 Specific Intake Assessment & Report - Sex Offender (5012) 4 Units Guaranteed Minimum; 30 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 Intake Screening - Sex Offender (6005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Individual Counseling - Sex Offender (6012) 40 Units Guaranteed Minimum; 620 Units Estimated Maximum

Option Year 1: 13 months through 24 months

40 EA $________ $_________________

15BCTS23Q00000002 Page 11 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Group Counseling - Sex Offender (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Family Counseling - Sex Offender (6032) 4 Units Guaranteed Minimum; 48 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Substance Use Intake Screening (2005) 4 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Substance Use Individual Counseling (2010) 1800 Units Guaranteed Minimum; 11200 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Substance Use Intake Assessment & Report (2011) 20 Units Guaranteed Minimum; 150 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Dual Diagnosis Intake Assessment & Report (2012) 4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Substance Use Group Counseling (2020) 2400 Units Guaranteed Minimum; 13500 Units Estimated Maximum

2,400 EA $________ $_________________

15BCTS23Q00000002 Page 12 of 68

Option Year 2: 25 months through 36 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Substance Use Family Counseling (2030) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Buprenorphine Follow-Up and Report - MAT (4002) 8 Unit Guaranteed Minimum; 140 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Naltrexone Follow-Up and Report - MAT (4003) 4 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Administration of Naltrexone - MAT (4040) 2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Psychiatric Evaluation & Report - MAT (4050) 8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Intake Screening - Mental Health (5005) 4 Units Guaranteed Minimum; 55 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 13 of 68

0060 Intake Assessment & Report - Mental Health (5011) 30 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Psychiatric Evaluation & Report - Mental Health (5030) 30 Unit Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Crisis Intervention Evaluation & Report (6000) 4 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Individual Counseling - Mental Health (6010) 320 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

320 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Case Management Services - Mental Health (6030) 4 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Family Counseling - Mental Health (6031) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Administration of Medication - Mental Health (6050) 2 Units Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 2: 25 months through 36 months

15BCTS23Q00000002 Page 14 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Medication Monitoring and Report - Mental Health (6051) 20 Units Guaranteed Minimum; 350 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Specific Intake Assessment & Report - Sex Offender (5012) 4 Units Guaranteed Minimum; 30 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 Intake Screening - Sex Offender (6005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 Individual Counseling - Sex Offender (6012) 40 Units Guaranteed Minimum; 620 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Group Counseling - Sex Offender (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 Family Counseling - Sex Offender (6032) 4 Units Guaranteed Minimum; 48 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Substance Use Intake Screening (2005) 4 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000002 Page 15 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 Substance Use Individual Counseling (2010) 1800 Units Guaranteed Minimum; 11200 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 Substance Use Intake Assessment & Report (2011) 20 Units Guaranteed Minimum; 150 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Dual Diagnosis Intake Assessment & Report (2012) 4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Substance Use Group Counseling (2020) 2400 Units Guaranteed Minimum; 13500 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Substance Use Family Counseling (2030) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Buprenorphine Follow-Up and Report - MAT (4002) 8 Unit Guaranteed Minimum; 140 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 16 of 68

0080 Naltrexone Follow-Up and Report - MAT (4003) 4 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Administration of Naltrexone - MAT (4040) 2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Psychiatric Evaluation & Report - MAT (4050) 8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Intake Screening - Mental Health (5005) 4 Units Guaranteed Minimum; 55 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Intake Assessment & Report - Mental Health (5011) 30 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Psychiatric Evaluation & Report - Mental Health (5030) 30 Unit Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Crisis Intervention Evaluation & Report (6000) 4 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000002 Page 17 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Individual Counseling - Mental Health (6010) 320 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

320 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Case Management Services - Mental Health (6030) 4 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Family Counseling - Mental Health (6031) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Administration of Medication - Mental Health (6050) 2 Units Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Medication Monitoring and Report - Mental Health (6051) 20 Units Guaranteed Minimum; 350 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Specific Intake Assessment & Report - Sex Offender (5012) 4 Units Guaranteed Minimum; 30 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Intake Screening - Sex Offender (6005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000002 Page 18 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Individual Counseling - Sex Offender (6012) 40 Units Guaranteed Minimum; 620 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 Group Counseling - Sex Offender (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 Family Counseling - Sex Offender (6032) 4 Units Guaranteed Minimum; 48 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0097 Substance Use Intake Screening (2005) 4 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Substance Use Individual Counseling (2010) 1800 Units Guaranteed Minimum; 11200 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

1,800 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 Substance Use Intake Assessment & Report (2011) 20 Units Guaranteed Minimum; 150 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 19 of 68

0100 Dual Diagnosis Intake Assessment & Report (2012) 4 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Substance Use Group Counseling (2020) 2400 Units Guaranteed Minimum; 13500 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

2,400 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Substance Use Family Counseling (2030) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Buprenorphine Follow-Up and Report - MAT (4002) 8 Unit Guaranteed Minimum; 140 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 Naltrexone Follow-Up and Report - MAT (4003) 4 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Administration of Naltrexone - MAT (4040) 2 Units Guaranteed Minimum; 60 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Psychiatric Evaluation & Report - MAT (4050) 8 Units Guaranteed Minimum; 40 Units Estimated Maximum

Option Year 4: 49 months through 60 months

8 EA $________ $_________________

15BCTS23Q00000002 Page 20 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Intake Screening - Mental Health (5005) 4 Units Guaranteed Minimum; 55 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0108 Intake Assessment & Report - Mental Health (5011) 30 Units Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 Psychiatric Evaluation & Report - Mental Health (5030) 30 Unit Guaranteed Minimum; 120 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

30 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 Crisis Intervention Evaluation & Report (6000) 4 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Individual Counseling - Mental Health (6010) 320 Units Guaranteed Minimum; 4800 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

320 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Case Management Services - Mental Health (6030) 4 Units Guaranteed Minimum; 80 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0113 Family Counseling - Mental Health (6031) 4 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 4: 49 months through 60 months

15BCTS23Q00000002 Page 21 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Administration of Medication - Mental Health (6050) 2 Units Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Medication Monitoring and Report - Mental Health (6051) 20 Units Guaranteed Minimum; 350 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Specific Intake Assessment & Report - Sex Offender (5012) 4 Units Guaranteed Minimum; 30 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Intake Screening - Sex Offender (6005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Individual Counseling - Sex Offender (6012) 40 Units Guaranteed Minimum; 620 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

40 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 Group Counseling - Sex Offender (6022) 4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 22 of 68

0120 Family Counseling - Sex Offender (6032) 4 Units Guaranteed Minimum; 48 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Substance Use Intake Screening (2005) 2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0122 Substance Use Individual Counseling (2010) 900 Units Guaranteed Minimum; 5600 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

900 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0123 Substance Use Intake Assessment & Report (2011) 10 Units Guaranteed Minimum; 75 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0124 Dual Diagnosis Intake Assessment & Report (2012) 2 Units Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0125 Substance Use Group Counseling (2020) 1200 Units Guaranteed Minimum; 6750 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1,200 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0126 Substance Use Family Counseling (2030) 2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

15BCTS23Q00000002 Page 23 of 68

QUANTITY

UNIT UNIT PRICE AMOUNT

0127 Buprenorphine Follow-Up and Report - MAT (4002) 4 Unit Guaranteed Minimum; 70 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0128 Naltrexone Follow-Up and Report - MAT (4003) 2 Unit Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0129 Administration of Naltrexone - MAT (4040) 1 Units Guaranteed Minimum; 30 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0130 Psychiatric Evaluation & Report - MAT (4050) 4 Units Guaranteed Minimum; 20 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

4 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0131 Intake Screening - Mental Health (5005) 2 Units Guaranteed Minimum; 28 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0132 Intake Assessment & Report - Mental Health (5011) 15 Units Guaranteed Minimum; 60 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0133 Psychiatric Evaluation & Report - Mental Health (5030) 15 Unit Guaranteed Minimum; 60 Units Estimated Maximum

Potential 6 Month Extension

15 EA $________ $_________________

15BCTS23Q00000002 Page 24 of 68

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0134 Crisis Intervention Evaluation & Report (6000) 2 Units Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0135 Individual Counseling - Mental Health (6010) 160 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

160 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0136 Case Management Services - Mental Health (6030) 2 Units Guaranteed Minimum; 40 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0137 Family Counseling - Mental Health (6031) 2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0138 Administration of Medication - Mental Health (6050) 1 Units Guaranteed Minimum; 10 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0139 Medication Monitoring and Report - Mental Health (6051) 10 Units Guaranteed Minimum; 175 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

15BCTS23Q00000002 Page 25 of 68

0140 Specific Intake Assessment & Report - Sex Offender (5012) 2 Units Guaranteed Minimum; 15 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0141 Intake Screening - Sex Offender (6005) 1 Units Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0142 Individual Counseling - Sex Offender (6012) 20 Units Guaranteed Minimum; 310 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0143 Group Counseling - Sex Offender (6022) 2 Units Guaranteed Minimum; 480 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0144 Family Counseling - Sex Offender (6032) 2 Units Guaranteed Minimum; 24 Units Estimated Maximum

Potential 6 Month Extension

15BCTS23Q00000002 Page 26 of 68

Section 3 - Contract Clauses

A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022)

The terms and conditions for the following clauses are hereby incorporated into this solicitation and resulting contract as an addendum to FAR clause 52.212-4.

Clauses By Reference

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.acquisition.gov

Clause Title Fill-ins (if applicable)

52.242-15 Stop-Work Order (Aug 1989)

52.203-3 Gratuities (Apr 1984)

52.232-40 Providing Accelerated Payments to Small Business Subcontractors

(Dec 2013)

52.253-1 Computer Generated Forms (Jan 1991)

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial

Services (Nov 2021)

52.203-12 Limitation On Payments To Influence Certain Federal Transactions

(Oct 2010)

52.242-13 Bankruptcy (July 1995)

52.224-1 Privacy Act Notification (Apr 1984)

52.224-2 Privacy Act (Apr 1984)

52.204-12 Unique Entity Identifier Maintenance (Oct 2016)

52.204-13 System for Award Management Maintenance (Oct 2018)

Clauses By Full Text

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

15BCTS23Q00000002 Page 27 of 68

(a)Sandra Hargesheimer, Supervisory Community Treatment Coordinator 202-305-5423; Nicole Foster, Community Treatment Coordinator 202-598-9740; Cynthia Benik, Community Treatment Oversight Specialist 202-451-7227 ,Ashanti Black, Community Treatment Oversight Specialist 202-451-7225; Sabina Medvinsky, Community Treatment Oversight Specialist 202-451-7226 , Ewelina Rozkuszka, Community Treatment Oversight Specialist 202-451-7228; Jeanine Stank, Community Treatment Oversight Specialist 202-451-7224; Mayelin Ugarte, Management Analyst 202-598-9246,Northeast Regional Office US Custom House, 7th Floor 2nd & Chestnut, Philadelphia, PA 19106 , is hereby designated as the Contracting Officer's Representative (COR) under this contract.

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

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

DOJ-05 Security of Department Information and Systems (APR 2015)

I. Applicability to Contractors and Subcontractors

This clause applies to all contractors and subcontractors, including cloud service providers (“CSPs”), and personnel of contractors, subcontractors, and CSPs (hereinafter collectively, “Contractor”) that may access, collect, store, process, maintain, use, share, retrieve, disseminate, transmit, or dispose of DOJ Information. It establishes and implements specific DOJ requirements applicable to this Contract. The requirements established herein are in addition to those required by the Federal Acquisition Regulation (“FAR”), including FAR 11.002(g) and 52.239-1, the Privacy Act of 1974, and any other applicable laws, mandates, Procurement Guidance Documents, and Executive Orders pertaining to the development and operation of Information Systems and the protection of Government Information. This clause does not alter or diminish any existing rights, obligation or liability under any other civil and/or criminal law, rule, regulation or mandate.

II. General Definitions

The following general definitions apply to this clause. Specific definitions also apply as set forth in other paragraphs.

A. Information means any communication or representation of knowledge such as facts, data, or opinions, in any form or medium, including textual, numerical, graphic, cartographic, narrative, or audiovisual. Information includes information in an electronic format that allows it be stored, retrieved or transmitted, also referred to as “data,” and “personally identifiable information” (“PII”), regardless of form.

B. Personally Identifiable Information (or PII) means any information about an individual maintained by an agency, including, but not limited to, information related to education, financial transactions, medical history, and criminal or employment history and information, which can be used to distinguish or trace an individual's identity, such as his or her name, social security number, date and place of birth, mother's maiden name, biometric records, etc., including any other personal information which is linked or linkable to an individual.

C. DOJ Information means any Information that is owned, produced, controlled, protected by, or otherwise within the custody or responsibility of the DOJ, including, without limitation, Information related to DOJ programs or personnel. It includes, without limitation, Information (1) provided by or generated for the DOJ, (2) managed or acquired by Contractor for the DOJ in connection with the performance of the contract, and/or (3) acquired in order to perform the contract.

D. Information System means any resources, or set of resources organized for accessing, collecting, storing, processing, maintaining, using, sharing, retrieving, disseminating, transmitting, or disposing of (hereinafter collectively, “processing, storing, or transmitting”) Information.

E. Covered Information System means any information system used for, involved with, or allowing, the processing, storing, or transmitting of DOJ Information.

15BCTS23Q00000002 Page 28 of 68

III. Confidentiality and Non-disclosure of DOJ Information

A. Preliminary and final deliverables and all associated working papers and material generated by Contractor containing DOJ Information are the property of the U.S. Government and must be submitted to the Contracting Officer (“CO”) or the CO’s Representative (“COR”) at the conclusion of the contract. The U.S. Government has unlimited data rights to all such deliverables and associated working papers and materials in accordance with FAR 52.227-14.

B. All documents produced in the performance of this contract containing DOJ Information are the property of the U.S.

Government and Contractor shall neither reproduce nor release to any third-party at any time, including during or at expiration or termination of the contract…