Sol_A15PS00121_Amd_000003.pdf

(x)

A15PS00121

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted , such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

A09

Gallup NM 87301 Contracting Office

301 WEST HILL ROOM 346

BIA NAVAJO 00009

01/13/2015000003

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended , by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

01/13/2015

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Amendment NO.: 003 is for Solicitation No.: A15PS00121 is as follows:

1. TO INCLUDE A REVISED STATEMENT OF WORK TO REPLACE THE ORIGINAL SOW.

2. ALL OTHER TERMS AND CONDITIONS TO REMAINTHE SAME

Period of Performance: 01/15/2015 to 06/30/2015

REVISED SOW:

Statement of Work

PSYCHOLOGICAL SERVICES

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

MARY JANE JOHNSON

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect .

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

A15PS00121/000003

Provide all travel, supplies, materials and personnel to provide Psychological Services in accordance with the Statement of Work (SOW) for a

Bureau of Indian Education School located at

Beclabito Day School, Beclabito, New Mexico.

Background: The Bureau of Indian Education, serves as a branch to the State Education Agency

(SEA) for several elementary and secondary schools and dormitories serving students located in the states of Arizona, New Mexico, and Utah.

The scope of work calls for professional related services to assist Beclabito Day School in implementing the special education and related services as authorized under P.L. 108-446

Individualized with Disabilities Education

Improvement Act (IDEIA). The purpose for the

IDEIA program is to improve academic achievement of students with disabilities and to introduce strict accountability measures holding schools, districts, and states responsible for the academic results of student with disabilities.

Approximately 49 schools will be funded Part B

Funds through a formula based process to provide special education and related services for eligible children with disabilities.

POSITION: Licensure Requirement ¿ Licensed

Psychologist: The contractor is required to be licensed in the State of _New Mexico, and shall have an active license in place throughout the life of the contract.

BIE SCHOOL: Beclabito Day School

LOCATION: Beclabito, New Mexico.

IDENTIFIED STUDENTS: Based upon the need over the past five years at Beclabito Day School, the total hours anticipated (based upon the students

IEP) is 96 hours onsite per year plus preparation time.

OBJECTIVES: To ensure the provision of

Psychological Services for identified or referred

Special Education students attending BIE, Beclabito Day School are met. Services will be provided in accordance with P.L. 108-446, the

Individuals with Disabilities Education Act of

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

A15PS00121/000003

2004 as specified in the student IEP.

1. Observes, screens, evaluates students and provides documentation for students referred for therapy services;

2. Assesses and plans treatment for qualifying students;

3. Attends and participates on multi-disciplinary teams to develop Individual

Educational Plans (IEP) and makes placement recommendations;

4. Assist the teacher in modifying classroom activities which promote motor development, prevent secondary problems and will allow each child to participate as much as possible; in collaboration with occupation therapy, assist classroom personnel with activities of daily living such as mobility, toileting and positioning by teaching them appropriate techniques;

6. Develop an individual educational program for physical therapy to fit the special needs of disabled students;

7. Interpret the psychological therapy evaluation, goals, and program plan to parents, provide instruction about appropriate activities at home, about exercises to be performed at home, about methods for meeting activities of daily living, and about equipment needs of the child;

8. Recommend: (a) general equipment for the psychological therapy department and see that it is maintained properly; (b) classroom equipment needs and design modifications to meet individual needs; (c) architectural modifications which will allow children to be more functional;

9. Document the psychological therapy evaluation and objective recordings of progress on individual children and maintain data related to physical therapy services with those of other disciplines you request.

10. Communicate with the providers of primary medical care of each disabled child receiving psychological therapy prior to and during the school year;

11. Reinforce appropriate levels of function in activities of daily living;

12. Develop good rapport and communication with parents through phone calls, letters and visitations;

13. Serve on educational committees, e.g., placement, IEP committees;

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

A15PS00121/000003

14. Coordinate and maintain such record keeping as is necessary.

16. Comply with all federal mandates, State Board of Education regulations, and BIE policies for service to the disabled;

17. Maintain working student file.

RESPONSIBILITIES OF PSYCHOLOGIST SERVICE

PROVIDERS: The service provider is to:

1. Report to a designated time and place for orientation to the organizational structure for service provision and the procedures delineated for providing the above specified services.

2. The provider is to make any additional reports or supply data to the BIE which may be required to evaluate and report on the provision of related services.

3. Make appropriate travel arrangements including payment of costs to be paid upon completion of work assignment for scheduled works with the Beclabito Day School, a bureau operated school. Travel costs shall be in accordance with the Federal Travel Regulations and incorporated into the firm fixed price.

4. Provide written reports and other documentation of services i.e. evaluation forms, attendance sheets, etc. for specific services as requested by the BIE (Beclabito Day School).

5. Develop and provide all materials for professional development and technical assistance provided to schools, leadership team, staff, and/or BIE (Beclabito Day School).

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)