BID FORM- BH Evals Regions Capital, Eastern, Western 5 Year Contract- .xlsx
XLSX spreadsheet 33 KB Posted
- Solicitation number
- BPM053561
- Issued by
- Maryland
About this file
This is a Bid Form document for the Maryland Department of Juvenile Services (DJS) Community-Based Behavioral Health Evaluations contract (Solicitation No. 26-MULTI-CS-BH-001). The solicitation seeks contractors to provide behavioral health evaluations for adjudicated and pre-adjudicated delinquent youth across three regions: Capital South (Calvert, Charles, Montgomery, Prince George's, and St. Mary's counties), Eastern (Caroline, Cecil, Dorchester, Kent, Queen Anne's, Somerset, Talbot, Wicomico, and Worcester counties), and Western (Allegany, Carroll, Frederick, Garrett, and Washington counties). Services include psychological diagnostic evaluations and assessments, psychiatric evaluations and assessments, Certificate of Need (CON) psychiatric evaluations, psychosexual evaluations, psychological and psychiatric consultations, court appearances, and handling of missed appointments. The contract term is five years with option years exercisable at the Department's sole discretion. Estimated annual service volumes include 150 psychological evaluations, 20–50 updated evaluations depending on region, 15 psychological and psychiatric consultations each, 5 court appearances, 5 CON psychiatric evaluations, 3 updated CON evaluations, 50 psychosexual evaluations, and 100 missed appointments per year across all service categories.
Bidders must submit all unit prices and extended prices in dollars and cents with fully-loaded rates that include all labor, overhead, administrative expenses, and profit necessary to perform the work. All bid calculations must be rounded to the nearest cent, and every blank on the bid form must be completed; failure to do so may render the bid non-responsive and result in rejection. Virtual evaluations must be billed at a 20% reduction of the set fee. The bid form requires pricing for all five contract years and calculates a total evaluated bid price across all three regions, with award to be determined based on the lowest total evaluated bid price for the complete five-year term. Bidders must complete separate bid forms for each region and provide an overall bid summary, and an authorized signatory must sign and date all submissions with complete contact information and FEIN provided.
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Instructions
ATTACHMENT B - BID FORM INSTRUCTIONS
| Solicitation No:___________________ |
| In order to assist Bidders in the preparation of their Bid and to comply with the requirements of this solicitation, Bid Pricing Instructions and a Bid Form have been prepared. Bidders shall submit their Bid on the Bid Form in accordance with the instructions on the Bid Form and as specified herein. Do not alter the Bid Form or the Bid Form may be rejected. The Bid Form is to be signed and dated, where requested, by an individual who is authorized to bind the Bidder to the prices entered on the Bid Form. |
| The Bid Form is used to calculate the Bidder's TOTAL BID PRICE. Follow these instructions carefully when completing your Bid Form: |
| A) All Unit and Extended Prices must be clearly entered in dollars and cents, e.g., $24.15. Make your decimal points clear and distinct |
B) All Unit Prices must be the actual price per unit the State will pay for the specific item or service identified in this IFB and may not be contingent on any other factor or condition in any manner.
C) All calculations shall be rounded to the nearest cent, i.e., .344 shall be .34 and .345 shall be .35.
D) Any goods or services required through this IFB and proposed by the vendor at No Cost to the State must be clearly entered in the Unit Price, If appropriate, and Extended Price with $0.00.
E) Every blank in every Bid Form shall be filled in. Any blanks may result in the Bid being regarded as non-responsive and thus rejected. Any changes or corrections made to the Bid Form by the Bidder prior to submission shall be initialed and dated.
F) Except as instructed on the Bid Form, nothing shall be entered on or attached to the Bid Form that alters or proposes conditions or contingencies on the prices. Alterations and/or conditions usually render the Bid non-responsive, which means it will be rejected.
G) It is imperative that the prices included on the Bid Form have been entered correctly and calculated accurately by the Bidder and that the respective total pricing agree with the entries on the Bid Form. Any incorrect entries or inaccurate calculations by the Bidder will be treated as provided in COMAR 21.05.03.03E and 21.05.02.12, and may cause the Bid to be rejected.
H) If option years are included, Bidders must submit pricing for each option year. Any options to renew will be exercised at the sole discretion of the State and will comply with all terms and conditions in force at the time the option is exercised. If exercised, the option period shall be for a period identified in the IFB at the prices entered in the Bid Form.
I) All Bid prices entered below are to be fully loaded prices that include all costs/expenses associated with the provision of services as required by the IFB. The Bid price shall include, but is not limited to, all: labor, profit/overhead, general operating, administrative, and all other expenses and cost necessary to perform the work set forth in the solicitation. No other amounts will be paid to the Contractor. If labor rates are requested, those amounts shall be fully-loaded rates; no overtime amounts will be paid.
J) Unless indicated elsewhere in the IFB, sample amounts used for calculations on the Bid Form are typically estimates for bidding purposes only. The Department does not guarantee a minimum or maximum number of units or usage in the performance of this Contract.
K) Failure to adhere to any of these instructions may result in the Bid being deteremined non-responsive and rejected by the Department.
Capital South
| ATTACHMENT B - BID FORM | |
| Solicitation No 26-Multi-CS-BH-001 | |
| STATE OF MARYLAND | |
| DEPARTMENT OF JUVENILE SERVICES | |
| Community Based Behavioral Health Evaluations | |
| Capital South Region | |
| Calvert, Charles, Montgomery, Prince George's, and St. Mary's |
Bidders Name:
| Treatment Services | Estimated Units of Service per Year | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 |
| PSYCHOLOGICAL SERVICES | ||||||
| Psychological Diagnostic Evaluation/Assessment (min 60 minutes) | ||||||
| Estimated Psychological Evaluations (in person) | 150 | |||||
| Updated Psychological Evaluations | 20 | |||||
| Estimated Psychological Consultations | 15 | |||||
| Estimated Psychological Court Appearance per year | 5 | |||||
| Total Annual Cost of Psychological Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| PSYCHIATRIC SERVICES | ||||||
| Psychiatric Diagnostic Evaluaton/Assessment (min 60 minutes) | ||||||
| Estimated Psychiatric Evaluations (in person) | 50 | |||||
| Estimated Psychiatric Consultations | 15 | |||||
| Estimated Psychiatric Court Appearances per year | 5 | |||||
| Total Annual Cost of Psychiatric Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Certificate of Need (CON) Psychiatric Evaluations | ||||||
| Estimated CON Psychiatric Evaluations per year (in person) | 5 | |||||
| Updated CON Psychiatric Evaluations per year | 3 | |||||
| Total Annual Cost of CON Psychiatric Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Psychosexual Evaluations | ||||||
| Estimated Psychosexual Evaluations per year (in person) | 50 | |||||
| Total Annual Cost of Psychosexual Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Missed Appointments Not to Exceed $100 | ||||||
| Estimated Missed Appointments per year | 100 | |||||
| Total Annual Cost of Missed Appointments | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Price per Year | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| If any evaluation is completed virtually, the vendor is required to bill at a 20% reduction of the set fee. | ||||||
| Bid Price - Capital Region (Sum of ALL 5 Years) | $0.00 |
| Authorized Signature |
| Printed Name and Title |
Eastern
| ATTACHMENT B - BID FORM | |
| Solicitation No 26-MULTI-CS-BH-001 | |
| STATE OF MARYLAND | |
| DEPARTMENT OF JUVENILE SERVICES | |
| Community Based Behavioral Health Evaluations | |
| Eastern Region | |
| Caroline, Cecil, Dorchester, Kent, Queen Anne's, Somerset, Talbot, Wicomico, & Worcester |
Bidders Name:
| Treatment Services | Estimated Units of Service per Year | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 |
| PSYCHOLOGICAL SERVICES | ||||||
| Psychological Diagnostic Evaluation/Assessment (min 60 minutes) | ||||||
| Estimated Psychological Evaluations (in person) | 150 | |||||
| Updated Psychological Evaluations | 10 | |||||
| Estimated Psychological Consultations | 15 | |||||
| Estimated Psychological Court Appearance per year | 5 | |||||
| Total Annual Cost of Psychological Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| PSYCHIATRIC SERVICES | ||||||
| Psychiatric Diagnostic Evaluaton/Assessment (min 60 minutes) | ||||||
| Estimated Psychiatric Evaluations (in person) | 50 | |||||
| Estimated Psychiatric Consultations | 15 | |||||
| Estimated Psychiatric Court Appearances per year | 5 | |||||
| Total Annual Cost of Psychiatric Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Certificate of Need (CON) Psychiatric Evaluations | ||||||
| Estimated CON Psychiatric Evaluations per year (in person) | 5 | |||||
| Updated CON Psychiatric Evaluations per year | 3 | |||||
| Total Annual Cost of CON Psychiatric Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Psychosexual Evaluations | ||||||
| Estimated Psychosexual Evaluations per year (in person) | 50 | |||||
| Total Annual Cost of Psychosexual Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Missed Appointments Not to Exceed $100 | ||||||
| Estimated Missed Appointments per year | 100 | |||||
| Total Annual Cost of Missed Appointments | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Price per Year | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| If any evaluation is completed virtually, the vendor is required to bill at a 20% reduction of the set fee. | ||||||
| Bid Price - Eastern Region (Sum of ALL 5 Years) | $0.00 |
| Authorized Signature |
| Printed Name and Title |
Western
| ATTACHMENT B - BID FORM | |
| Solicitation No 26-MULTI-CS-BH-001 | |
| STATE OF MARYLAND | |
| DEPARTMENT OF JUVENILE SERVICES | |
| Community Based Behavioral Health Evaluations | |
| Western Region | |
| Allegany, Carroll, Frederick, Garrett & Washington Counties |
Bidders Name:
| Treatment Services | Estimated Units of Service per Year | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 |
| PSYCHOLOGICAL SERVICES | ||||||
| Psychological Diagnostic Evaluation/Assessment (min 60 minutes) | ||||||
| Estimated Psychological Evaluations (in person) | 150 | |||||
| Updated Psychological Evaluations | 10 | |||||
| Estimated Psychological Consultations | 15 | |||||
| Estimated Psychological Court Appearance per year | 5 | |||||
| Total Annual Cost of Psychological Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| PSYCHIATRIC SERVICES | ||||||
| Psychiatric Diagnostic Evaluaton/Assessment (min 60 minutes) | ||||||
| Estimated Psychiatric Evaluations (in person) | 50 | |||||
| Estimated Psychiatric Consultations | 15 | |||||
| Estimated Psychiatric Court Appearances per year | 5 | |||||
| Total Annual Cost of Psychiatric Services | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Certificate of Need (CON) Psychiatric Evaluations | ||||||
| Estimated CON Psychiatric Evaluations per year (in person) | 5 | |||||
| Updated CON Psychiatric Evaluations per year | 3 | |||||
| Total Annual Cost of CON Psychiatric Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Psychosexual Evaluations | ||||||
| Estimated Psychosexual Evaluations per year (in person) | 50 | |||||
| Total Annual Cost of Psychosexual Evaluations | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Missed Appointments Not to Exceed $100 | ||||||
| Estimated Missed Appointments per year | 100 | |||||
| Total Annual Cost of Missed Appointments | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Price per Year | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| If any evaluation is completed virtually, the vendor is required to bill at a 20% reduction of the set fee. | ||||||
| Bid Price - Western Region (Sum of ALL 5 Years) | $0.00 |
| Authorized Signature |
| Printed Name and Title |
Bid Summary
| ATTACHMENT B - BID FORM | |
| Solicitation No 26-MULTI-CS-BH-001 | |
| STATE OF MARYLAND | |
| DEPARTMENT OF JUVENILE SERVICES | |
| Community Based Behavioral Health Evaluations |
| Regional Area | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Total Evaluated Bid Price |
| Capital South Region | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Eastern Region | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Western Region | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Award Basis-Total Evaluated Bid Price | $0.00 |
Authorized Signature Date
Printed Name and Title
Bidder's Name
Bidder's Address
FEIN eMMA#
Contact Information of Above Authorized Signatory:
Telephone Fax
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