RFQ - 75H71524Q00011 Youth Psychologist.pdf
PDF 192 KB Posted
- Attached to
- P/T Youth Psychologist - King William, VA
- Solicitation number
- 75H71524Q00011
About this file
This document is a Request for Quote (RFQ) for a Part-Time Youth Psychologist to provide psychological services at the Pamunkey Indian Reservation in King William, VA. The contractor shall provide a Youth Psychologist to offer direct care services two days every other week, with Wednesdays on-site and Thursdays for documentation and case management. The required services include intake assessments, individual and family therapy, crisis intervention, consultation, and case management. The period of performance is 12 months from 09/01/2024 to 08/31/2025. The solicitation number is 75H71524Q00011, and the total estimated hours are 416 with a loaded hourly rate to be proposed. This is a fixed-price, non-personal services contract issued by the Department of Health and Human Services' Indian Health Service.
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Other files
| File | Type | Posted |
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| Combined Syn II.pdf | ||
| BIA - Certification.pdf | ||
| SOW Youth Psychologist.pdf | ||
| Requirements Document.pdf | ||
| Terms and Conditions - Pharamcist.pdf | ||
| RFQ - Beta.Sam.pdf | ||
| Submittal Instructions and Evaluation Factors.pdf |
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SEE ADDENDUMIS CHECKED
CODE 18a. PAYMENT WILL BE MADE BY
CODE
FACILITYCODE
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER
OFFEROR
CODE 16. ADMINISTERED BYCODE
X
X
X
624110
SIZE STANDARD:
% FOR:SET ASIDE:UNRESTRICTED OR139
REQUEST FOR
PROPOSAL
(RFP)
INVITATION
FOR BID (IFB)
10. THIS ACQUISITION ISCODE
REQUEST FOR
QUOTE (RFQ)
14. METHOD OF SOLICITATION
13b. RATING
NORTH AMERICAN INDUSTRY
CLASSIFICATION STANDARD
(NAICS):
SMALL BUSINESS
08/15/2024 1700 ET
08/01/2024
DARRYL SMITH
(No collect calls)
INFORMATION CALL:
FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME
4. ORDER NUMBER3. AWARD/ 6. SOLICITATION
75H71524Q00011
5. SOLICITATION NUMBER
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF
1 2 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
TELEPHONE NO.
17a. CONTRACTOR/
15. DELIVER TO
Nashville TN 37214 711 Stewarts Ferry Pike
9. ISSUED BY
7.
2. CONTRACT NO.
EFFECTIVE DATE
$15.5
18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW
ISSUE DATE
DELIVERY FOR FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
11.
SEE SCHEDULEX
12. DISCOUNT TERMS THIS CONTRACT IS A RATED
ORDER UNDER THE DEFENSE
PRIORITIES AND ALLOCATIONS
SYSTEM - DPAS (15 CFR 700)
13a.
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
HUBZONE SMALL
BUSINESS
Nashville Area Office
WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL
BUSINESS (EDWOSB)
Indian Owned Business
24.
AMOUNT
23.
UNIT PRICE
22.
UNIT
21.
QUANTITY
20.
SCHEDULE OF SUPPLIES/SERVICES
19.
ITEM NO.
The contractor shall provide a Youth Psychologist to provide youth counseling and psychological assessments on site every other Wednesday - Thursdays may be used for documentation, report writing, and case management.
Service to be rendered on the mobile health unit at Pamunkey Indian Reservation located at 175 Lay Landing, King William, VA
(Use Reverse and/or Attach Additional Sheets as Necessary)
HEREIN, IS ACCEPTED AS TO ITEMS:
DATED . YOUR OFFER ON SOLICITATION (BLOCK 5),
INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER
ARE
ARE
31c. DATE SIGNED
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)
30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)
ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL
SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.
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
26. TOTAL AWARD AMOUNT (For Government Use Only)
OFFER
STANDARD FORM 1449 (REV. 11/2021)
Prescribed by GSA - FAR (48 CFR) 53.212
ARE NOT ATTACHED.
ARE NOT ATTACHED.
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
30b. NAME AND TITLE OF SIGNER (Type or print)
30a. SIGNATURE OF OFFEROR/CONTRACTOR
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN
25. ACCOUNTING AND APPROPRIATION DATA
29. AWARD OF CONTRACT: REFERENCE
x
32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:
32a. QUANTITY IN COLUMN 21 HAS BEEN
RECEIVED INSPECTED
40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER
37. CHECK NUMBER
FINALPARTIAL
36. PAYMENT
FINALPARTIAL
35. AMOUNT VERIFIED
CORRECT FOR
34. VOUCHER NUMBER33. SHIP NUMBER
COMPLETE
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)
42b. RECEIVED AT (Location)
42a. RECEIVED BY (Print)
41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER
41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT
STANDARD FORM 1449 (REV. 11/2021) BACK
24.
AMOUNT
23.
UNIT PRICE
22.
UNIT
21.
QUANTITY
20.
SCHEDULE OF SUPPLIES/SERVICES
19.
ITEM NO.
1 Behavioral Health Services
Youth Psychologist
Period of performance: 12 Months (P/T)
Total Hours: 416
Loaded hourly rate:_______________
Total Cost:
Period of Performance: 09/01/2024 to 08/31/2025
32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
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