SOL-15BCTS21Q00000026.pdf

U. S. Department of Justice

Federal Bureau of Prisons

Washington, D.C. 20534

18, 2021 February

Re: 15BCTS21Q00000026, West Palm Beach, FL

All Interested Parties:

This Request for Quotation (RFQ) is to provide Mental Health and

Substance Use Treatment services for male and female offenders held under authority of the United States in West Palm Beach, FL.

Services are to be provided in accordance with the enclosed

Statement of Work entitled, “Federal Bureau of Prisons, Community

Treatment Services, Statement of Work, October 2020.”

The following must be completed and submitted with your Quotation:

Standard Form (SF) 1449 - Solicitation/Contract/Order for

Commercial Items - Please complete blocks 12, 17a, 17b, 23, 24, 30a, 30b, and 30c of the SF-1449 and the continuation sheets.

Please include your telephone number in Block 17a. Original signatures are required.

Quoter Representations and Certifications (FAR 52.212-3) -

Prospective quoters are required to submit Annual

Representations and Certifications at https://www.sam.gov/portal/public/SAM/. By submission of a quote under this solicitation, the quoter acknowledges completion of the annual representations and certifications via

SAM and verifies, by the submission of the quote, that the representations and certifications currently posted in SAM were entered or updated within the last 12 months and are current, accurate, complete and applicable to this solicitation. All quoters must be capable of and comply with FAR 52.212-1(j), Instructions to Offerors - Commercial Items, Unique Entity

Identifier (Jun 2020) and FAR 52.204-7, System of Award

Management(SAM) (Oct 2018).

Required Documentation Identified at Addendum to FAR 52.212-1, Instructions to Offerors - Commercial Items

Government shall award to the lowest price, technically http://www.sam.gov/portal/public/SAM/ acceptable, responsive and responsible quoter.

Electronic copies of quotations shall be submitted by email in

Adobe Acrobat (PDF) format only. Email attachments (PDFs only) cannot total more than 14 MB per email. Please compress PDFs when possible to reduce the file size. We understand you will likely need to send multiple emails. Please include SEPARATE

FILE ATTACHMENTS for the following:

Completed SF-1449 (including the pricing table at Section 2.1)

Completed Business Quotation Information sheet

Completed Technical Quotation Information packet

Proof of completed SAM registration (must be Active by time of quotation submission)

A copy of your current Professional Liability Insurance

Quotations shall be emailed by Tuesday, March 16, 2021, 12:00 P.M. CDT to g3clark@bop.gov. Please confirm that all emails and attachments were received.

The solicitation will be distributed solely through the General

Services Administration’s Beta SAM.gov website (beta.sam.gov).

Hard copies of the solicitation document will not be available. The website provides downloading instructions. All future information about this solicitation, including solicitation amendments, will 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 g3clark@bop.gov.

Sincerely, Gary Clark

Contracting Officer mailto:g3clark@bop.gov file://///copc_admgrp_server/ADMGRP/Groups/OCC/SHAREDOC/PCC/TDAT%20Services/2%20-%20SOL-CON%20--%20Final%20Docs/Southeast/RFQ-TDAT-025-11%20Jacksonville,%20FL/Flap%20B/Tab%205%20-%20Pre-sol%20Review/(http:/www.fedbizopps.gov).

mailto:g3clark@bop.gov

15BCTS21Q00000026 Page 1 of 82

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

15BCTS21Q00000026

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

02/18/2021

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Gary Clark g3clark@bop.gov

b. TELEPHONE NUMBER (No collect calls)

202-598-3478

8. OFFER DUE DATE / LOCAL

TIME

03/16/2021 12:00 CT

CODE BCTS

Federal Bureau of Prisons Acquisitions Branch/Community Treatment Svcs Contracting 320 First Street NW Room 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

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD: $16,500,000

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

BSERCODE15. DELIVER TO

Federal Bureau of Prisons Atlanta Field Office Community Treatment Services (CTS) 719 McDonough Blvd, SE Atlanta, GA 30315

CODE BCTS16. ADMINISTERED BY

Federal Bureau of Prisons Acquisitions Branch/Community Treatment Svcs Contracting Maxwell AFB, Bldg 1209 820 Willow Street Montgomery, AL 36112

Gary Clark

(O) 202-598-3478 g3clark@bop.gov

FACILITY

CODE

CODE

TELEPHONE NO.

17a. CONTRACTOR/

OFFEROR

15B300CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons Atlanta Field Office Community Treatment Services (CTS) 719 McDonough Blvd, SE Atlanta, GA 30315

BOP-RSD-PSBCTS-BILL@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

Substance Use, Mental Health, Sex Offender and Medication Assisted Treatment Services in West Palm Beach, FL

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 X ARE 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) 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

RCA#26-21

621420

15BCTS21Q00000026 Page 2 of 82

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

15BCTS21Q00000026 Page 3 of 82

Table of Contents

Section Description Page Number

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

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

52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE

2004)

52.218-000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA

OR OTHER NATIONAL EMERGENCY (May 2008) DJAR-PGD-15-03 Security of Department Information and Systems 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-21 Requirements (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) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders- Commercial Items (Jan 2021)

4 List of Attachments 5 Solicitation Provisions

52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb 2016) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Oct 2020) 52.209-7 Information Regarding Responsibility Matters (Oct 2018) 52.212-3 Offeror Representations and Certifications- Commercial Items (Feb 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)

15BCTS21Q00000026 Page 4 of 82

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) (one per inmate) for Estimated 10 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 64 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

3,072 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0003 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 35 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 35 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 64 Inmates Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

4,608 EA $________ $_________________

15BCTS21Q00000026 Page 5 of 82

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 4 Inmates Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 MAT- Buprenorphine Follow-Up and Report (4002) Estimated 6 Units per Inmate for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 MAT - Naltrexone Follow-Up and Report (4003) Estimated 6 Units per Inmate for Estimated 4 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 MAT - Administration of Buprenorphine (4020) Estimated 168 Units per Inmate for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0010 MAT - Buprenorphine and Administration (4021) Estimated 168 Units per Inmate for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 MAT - Administration of Buprenorphine Injection (4030) Estimated 6 Units per Inmate for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

12 EA $________ $_________________

15BCTS21Q00000026 Page 6 of 82

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 MAT - Buprenorphine and Administration of Injection (4031) Estimated 6 Units per Inmate for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 MAT - Administration of Naltrexone (4040) Estimated 6 Units per Inmate for Estimated 4 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 MAT - Naltrexone and Administration (4041) Estimated 6 Units per Inmate; Estimated 4 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 MAT - Psychiatric Evaluation & Report (4050) Estimated 1 Units per Inmate; Estimated 6 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 Mental Health Intake Screening (5005) (one per inmate) for Estimated 10 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Mental Health Intake Assessment & Report (5011) (one per inmate) for Estimated 15 Inmates

Base Period: Date of award - 12 months

15 EA $________ $_________________

15BCTS21Q00000026 Page 7 of 82

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Psychiatric Evaluation & Report (5030) (one per inmate) for Estimated 15 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 Crisis Intervention Evaluation & Report (6000) (one per inmate) for Estimated 2 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Mental Health Individual Counseling (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 26 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

1,248 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0021 Mental Health Group Counseling (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 26 Inmates Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

1,248 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0022 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

18 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Mental Health Family Counseling (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3

9 EA $________ $_________________

15BCTS21Q00000026 Page 8 of 82

Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 26 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

156 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Medication Monitoring and Report (6051) (5 visits per inmate) for Estimated 26 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

130 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Sex Offender Specific Intake Assessment & Report (5012) (one per inmate) for Estimated 3 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Sex Offender Intake Screening (6005) (one per inmate) for Estimated 3 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0028 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 3 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

144 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

15BCTS21Q00000026 Page 9 of 82

0029 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 3 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

216 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates

Base Period: Date of award - 12 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Substance Use Intake Screening (2005) (one per inmate) for Estimated 35 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

35 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 35 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

1,680 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0033 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 35 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0034 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 35 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

35 SS $________ $_________________

15BCTS21Q00000026 Page 10 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0035 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 35 Inmates Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

2,520 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0036 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 35 Inmates Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

105 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 MAT- Buprenorphine Follow-Up and Report (4002) Estimated 6 Units per Inmate for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0038 MAT - Naltrexone Follow-Up and Report (4003) Estimated 6 Units per Inmate for Estimated 4 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 MAT - Administration of Buprenorphine (4020) Estimated 168 Units per Inmate for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 MAT - Buprenorphine and Administration (4021) Estimated 168 Units per Inmate for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

336 EA $________ $_________________

15BCTS21Q00000026 Page 11 of 82

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0042 MAT - Administration of Buprenorphine Injection (4031) Estimated 6 Units per Inmate for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 MAT - Administration of Naltrexone (4040) Estimated 6 Units per Inmate for Estimated 4 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0044 MAT - Naltrexone and Administration (4041) Estimated 6 Units per Inmate; Estimated 4 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0045 MAT - Psychiatric Evaluation & Report (4050) Estimated 1 Units per Inmate; Estimated 6 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0046 Mental Health Intake Screening (5005) (one per inmate) for Estimated 10 Inmates

Option Year 1: 13 months through 24 months

10 EA $________ $_________________

15BCTS21Q00000026 Page 12 of 82

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0047 Mental Health Intake Assessment & Report (5011) (one per inmate) for Estimated 15 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Psychiatric Evaluation & Report (5030) (one per inmate) for Estimated 15 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Crisis Intervention Evaluation & Report (6000) (one per inmate) for Estimated 2 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0050 Mental Health Individual Counseling (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0051 Mental Health Group Counseling (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates

18 EA $________ $_________________

15BCTS21Q00000026 Page 13 of 82

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0053 Mental Health Family Counseling (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Medication Monitoring and Report (6051) (5 visits per inmate) for Estimated 15 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Sex Offender Specific Intake Assessment & Report (5012) (one per inmate) for Estimated 3 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Sex Offender Intake Screening (6005) (one per inmate) for Estimated 3 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0058 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 3 Inmates

144 EA $________ $_________________

15BCTS21Q00000026 Page 14 of 82

Firm Fixed Price

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0059 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 3 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

216 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0060 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates

Option Year 1: 13 months through 24 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Substance Use Intake Screening (2005) (one per inmate) for Estimated 35 Inmates

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

35 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 35 Inmates

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

1,680 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0063 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 35 Inmates

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 35 Inmates

15BCTS21Q00000026 Page 15 of 82

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 35 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

2,520 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 35 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

105 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 MAT- Buprenorphine Follow-Up and Report (4002) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 MAT - Naltrexone Follow-Up and Report (4003) Estimated 6 Units per Inmate for Estimated 4 Inmates

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0069 MAT - Administration of Buprenorphine (4020) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0070 MAT - Buprenorphine and Administration (4021) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 2: 25 months through 36 months

15BCTS21Q00000026 Page 16 of 82

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0071 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0072 MAT - Administration of Buprenorphine Injection (4031) Estimated 6 Units per Inmate for Estimated 2 Inmates

Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 MAT - Administration of Naltrexone (4040) Estimated 6 Units per Inmate for Estimated 4 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0074 MAT - Naltrexone and Administration (4041) Estimated 6 Units per Inmate; Estimated 4 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0075 MAT - Psychiatric Evaluation & Report(4050) Estimated 1 Units per Inmate; Estimated 6 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0076 Mental Health Intake Screening (5005) (one per inmate) for Estimated 10 Inmates Option Year 2: 25 months through 36 months

15BCTS21Q00000026 Page 17 of 82

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Mental Health Intake Assessment & Report (5011) (one per inmate) for Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0078 Psychiatric Evaluation & Report (5030) (one per inmate) for Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Crisis Intervention Evaluation & Report (6000) (one per inmate) for Estimated 2 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 Mental Health Individual Counseling (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Mental Health Group Counseling (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

15BCTS21Q00000026 Page 18 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0083 Mental Health Family Counseling (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0084 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 Medication Monitoring and Report (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0086 Sex Offender Specific Intake Assessment & Report (5012) (one per inmate) for Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Sex Offender Intake Screening (6005) (one per inmate) for Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0088 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

15BCTS21Q00000026 Page 19 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

216 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 2: 25 months through 36 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Substance Use Intake Screening (2005) (one per inmate) for Estimated 35 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

35 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0092 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 35 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

1,680 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 35 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0094 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 35 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

15BCTS21Q00000026 Page 20 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0095 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 35 Inmates Option Year 3: 37 months through 48 months Firm Fixed Price

PSC: G004

2,520 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0096 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 35 Inmates Option Year 3: 37 months through 48 months Firm Fixed Price

PSC: G004

105 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0097 MAT- Buprenorphine Follow-Up and Report (4002) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 MAT - Naltrexone Follow-Up and Report (4003) Estimated 6 Units per Inmate for Estimated 4 Inmates

Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0099 MAT - Administration of Buprenorphine (4020) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0100 MAT - Buprenorphine and Administration (4021) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

15BCTS21Q00000026 Page 21 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0101 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 MAT - Administration of Buprenorphine Injection (4031) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 MAT - Administration of Naltrexone (4040) Estimated 6 Units per Inmate for Estimated 4 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 MAT - Naltrexone and Administration (4041) Estimated 6 Units per Inmate; Estimated 4 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 MAT - Psychiatric Evaluation & Report (4050) Estimated 1 Units per Inmate; Estimated 6 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Mental Health Intake Screening (5005) (one per inmate) for Estimated 10 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

15BCTS21Q00000026 Page 22 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Mental Health Intake Assessment & Report (5011) (one per inmate) for Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0108 Psychiatric Evaluation & Report (5030) (one per inmate) for Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0109 Crisis Intervention Evaluation & Report (6000) (one per inmate) for Estimated 2 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0110 Mental Health Individual Counseling (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0111 Mental Health Group Counseling (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

15BCTS21Q00000026 Page 23 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0113 Mental Health Family Counseling (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Medication Monitoring and Report (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Sex Offender Specific Intake Assessment & Report (5012) (one per inmate) for Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0117 Sex Offender Intake Screening (6005) (one per inmate) for Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

15BCTS21Q00000026 Page 24 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0119 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

216 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0120 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 3: 37 months through 48 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Substance Use Intake Screening (2005) (one per inmate) for Estimated 35 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

35 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0122 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 35 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

1,680 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0123 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 35 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

35 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0124 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 35 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

15BCTS21Q00000026 Page 25 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0125 Substance Use Group Counseling (2020) (30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 35 Inmates Option Year 4: 49 months through 60 months Firm Fixed Price

PSC: G004

2,520 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0126 Substance Use Family Counseling (2030) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 35 Inmates Option Year 4: 49 months through 60 months Firm Fixed Price

PSC: G004

105 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0127 MAT- Buprenorphine Follow-Up and Report (4002) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0128 MAT - Naltrexone Follow-Up and Report (4003) Estimated 6 Units per Inmate for Estimated 4 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0129 MAT - Administration of Buprenorphine (4020) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

336 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0130 MAT - Buprenorphine and Administration (4021) Estimated 168 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

15BCTS21Q00000026 Page 26 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0131 Administration of Buprenorphine Injection - MAT (4030) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0132 MAT - Administration of Buprenorphine Injection (4031) Estimated 6 Units per Inmate for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

12 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0133 MAT - Administration of Naltrexone (4040) Estimated 6 Units per Inmate for Estimated 4 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0134 MAT - Naltrexone and Administration (4041) Estimated 6 Units per Inmate; Estimated 4 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

24 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0135 MAT - Psychiatric Evaluation & Report (4050) Estimated 1 Units per Inmate; Estimated 6 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

6 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0136 Mental Health Intake Screening (5005) (one per inmate) for Estimated 10 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

15BCTS21Q00000026 Page 27 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0137 Mental Health Intake Assessment & Report (5011) (one per inmate) for Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0138 Psychiatric Evaluation & Report (5030) (one per inmate) for Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0139 Crisis Intervention Evaluation & Report (6000) (one per inmate) for Estimated 2 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0140 Mental Health Individual Counseling (6010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0141 Mental Health Group Counseling (6020) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

720 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0142 Case Management Services (6030) Estimated 3 Units per Inmate; Estimated 6 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

15BCTS21Q00000026 Page 28 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0143 Mental Health Family Counseling (6031) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0144 Administration of Medication (6050) Estimated 6 Units per Inmate; Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0145 Medication Monitoring and Report (6051) (5 visits per inmate) for Estimated 15 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

75 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0146 Sex Offender Specific Intake Assessment & Report (5012) (one per inmate) for Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0147 Sex Offender Intake Screening (6005) (one per inmate) for Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0148 Sex Offender Individual Counseling (6012) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

15BCTS21Q00000026 Page 29 of 82

QUANTITY

UNIT UNIT PRICE AMOUNT

0149 Sex Offender Group Counseling (6022) 30 Minutes = 1 Unit) Estimated 72 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

216 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0150 Sex Offender Family Counseling (6032) (30 Minutes = 1 Unit) Estimated 3 Units per Inmate; Estimated 3 Inmates Option Year 4: 49 months through 60 months

Firm Fixed Price

PSC: G004

9 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0151 Substance Use Intake Screening (2005) (one per inmate) for Estimated 18 Inmates 6 Month Extension: 61 months through 66 months

Firm Fixed Price

PSC: G004

18 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0152 Substance Use Individual Counseling (2010) (30 Minutes = 1 Unit) Estimated 48 Units per Inmate; Estimated 18 Inmates 6 Month Extension: 61 months through 66 months

Firm Fixed Price

PSC: G004

864 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0153 Substance Use Intake Assessment & Report (2011) (one per inmate) for Estimated 18 Inmates 6 Month Extension: 61 months through 66 months

Firm Fixed Price

PSC: G004

18 SS $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0154 Dual Diagnosis Intake Assessment & Report (2012) (one per inmate) for Estimated 18 Inmates 6 Month Extension: 61 months through 66 months

Firm Fixed Price

18 SS $________…