Solicitation 15BCTS23Q00000017.pdf

15BCTS23Q00000017 Page 1 of 70

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER PAGE 1 OF

5. SOLICITATION NUMBER

15BCTS23Q00000017

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

02/28/2023

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

Robert Carroll r1carroll@bop.gov

b. TELEPHONE NUMBER (No collect calls)

(202) 598-6124

8. OFFER DUE DATE / LOCAL

TIME

03/30/2023 14:00 ET

CODE 15BCTS

Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 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

15B400CODE15. DELIVER TO

Federal Bureau of Prisons North Central Regional Office

400 STATE AVENUE

SUITE 800

Kansas City, KS 66101

CODE 15BCTS16. ADMINISTERED BY

Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW Suite 901-5 Washington, DC 20534

Robert Carroll

(O) (202) 598-6124 r1carroll@bop.gov

FACILITY

CODE

CODE

TELEPHONE NO.

17a. CONTRACTOR/

OFFEROR

15B400CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons North Central Regional Office

400 STATE AVENUE

SUITE 800

Kansas City, KS 66101

BOP-RSD-CRBCTS-BILL-KC

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: 05/01/2023

Substance Use, Mental Health, Medication Assisted and Sex Offender Treatment Services in Salt Lake, Utah 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)

Robert Carroll

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

017-23

15BCTS23Q00000017 Page 2 of 70

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

15BCTS23Q00000017 Page 3 of 70

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) 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)

52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Dec 2022)

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) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Dec 2022) 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)

15BCTS23Q00000017 Page 4 of 70

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 Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0002 Substance Use Disorder Intake Screening (2005)

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

0003 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0004 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0005 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0006 Substance Use Disorder Group Counseling (2020) 120 EA $________ $_________________

15BCTS23Q00000017 Page 5 of 70

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0007 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0008 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0009 MAT - Intake Screening (4005)

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

0010 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0011 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0012 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Base Period: Date of award - 12 months

2 EA $________ $_________________

15BCTS23Q00000017 Page 6 of 70

PSC: G004

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0013 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0014 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0015 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0016 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0017 Mental Health Group Counseling (6020)

90 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0018 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Base Period: Date of award - 12 months

15BCTS23Q00000017 Page 7 of 70

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0019 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0020 Sex Offender Intake Assessment & Report (5012)

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

0021 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

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 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0023 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

20 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0024 Sex Offender Group Counseling (6022)

4 Units Guaranteed Minimum; 960 Units Estimated Maximum

Base Period: Date of award - 12 months

4 EA $________ $_________________

15BCTS23Q00000017 Page 8 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0025 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 Units Estimated Maximum

Base Period: Date of award - 12 months

PSC: G004

2 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0026 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0027 Substance Use Disorder Intake Screening (2005)

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

0028 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0029 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0030 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 1: 13 months through 24 months

5 EA $________ $_________________

15BCTS23Q00000017 Page 9 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0031 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0032 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 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

0033 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 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

0034 MAT - Intake Screening (4005)

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

0035 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 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

0036 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 1: 13 months through 24 months

15BCTS23Q00000017 Page 10 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0037 Mental Health Intake Screening (5005)

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

0038 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0039 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0040 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0041 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 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

0042 Mental Health Group Counseling (6020)

90 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 1: 13 months through 24 months

90 EA $________ $_________________

15BCTS23Q00000017 Page 11 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0043 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 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

0044 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 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

0045 Sex Offender Intake Assessment & Report (5012)

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 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

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

0047 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 1: 13 months through 24 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0048 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 Units Estimated Maximum

Option Year 1: 13 months through 24 months

20 EA $________ $_________________

15BCTS23Q00000017 Page 12 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0049 Sex Offender Group Counseling (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

0050 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 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

0051 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0052 Substance Use Disorder Intake Screening (2005)

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

0053 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0054 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 2: 25 months through 36 months

15 EA $________ $_________________

15BCTS23Q00000017 Page 13 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0055 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0056 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0057 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 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 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 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

0059 MAT - Intake Screening (4005)

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

0060 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 2: 25 months through 36 months

15BCTS23Q00000017 Page 14 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0061 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0062 Mental Health Intake Screening (5005)

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

0063 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0064 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0065 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0066 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 Units Estimated Maximum

Option Year 2: 25 months through 36 months

20 EA $________ $_________________

15BCTS23Q00000017 Page 15 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0067 Mental Health Group Counseling (6020)

90 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 2: 25 months through 36 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0068 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 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

0069 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 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 Sex Offender Intake Assessment & Report (5012)

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

0071 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

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

0072 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 2: 25 months through 36 months

1 EA $________ $_________________

15BCTS23Q00000017 Page 16 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0073 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 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

0074 Sex Offender Group Counseling (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

0075 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 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

0076 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0077 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 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

0078 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Option Year 3: 37 months through 48 months

100 EA $________ $_________________

15BCTS23Q00000017 Page 17 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0079 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0080 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0081 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0082 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 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

0083 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 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

0084 MAT - Intake Screening (4005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000017 Page 18 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0085 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 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

0086 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0087 Mental Health Intake Screening (5005)

2 Units Guaranteed Minimum; 25 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

0088 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0089 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0090 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 3: 37 months through 48 months

15BCTS23Q00000017 Page 19 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0091 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 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 Mental Health Group Counseling (6020)

90 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0093 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 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

0094 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 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

0095 Sex Offender Intake Assessment & Report (5012)

2 Units Guaranteed Minimum; 25 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

0096 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 3: 37 months through 48 months

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QUANTITY

UNIT UNIT PRICE AMOUNT

0097 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 3: 37 months through 48 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0098 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 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

0099 Sex Offender Group Counseling (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

0100 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 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

0101 Substance Use Disorder Treatment Planning and Follow-up (2001)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0102 Substance Use Disorder Intake Screening (2005)

2 Units Guaranteed Minimum; 25 Units Estimated Maximum

Option Year 4: 49 months through 60 months

15BCTS23Q00000017 Page 21 of 70

QUANTITY

UNIT UNIT PRICE AMOUNT

0103 Substance Use Disorder Individual Counseling (2010)

100 Units Guaranteed Minimum; 2400 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

100 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0104 Substance Use Disorder Intake Assessment & Report (2011)

15 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

15 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0105 Co-occurring Intake Assessment & Report (2012)

5 Units Guaranteed Minimum; 50 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0106 Substance Use Disorder Group Counseling (2020)

120 Units Guaranteed Minimum; 3960 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

120 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0107 Substance Use Disorder Relationship and Parenting Counseling (2030)

2 Units Guaranteed Minimum; 100 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

0108 MAT – Follow-Up & Report (4004)

2 Units Guaranteed Minimum; 100 Units Estimated Maximum

Option Year 4: 49 months through 60 months

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QUANTITY

UNIT UNIT PRICE AMOUNT

0109 MAT - Intake Screening (4005)

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

0110 MAT Psychiatric Evaluation & Report (4050)

2 Units Guaranteed Minimum; 50 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

0111 Mental Health Treatment Planning and Follow-up (5001)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0112 Mental Health Intake Screening (5005)

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

0113 Mental Health Intake Assessment & Report (5011)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

5 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0114 Psychiatric Evaluation & Report (5030)

5 Units Guaranteed Minimum; 75 Units Estimated Maximum

Option Year 4: 49 months through 60 months

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QUANTITY

UNIT UNIT PRICE AMOUNT

0115 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0116 Mental Health Individual Counseling (6010)

20 Units Guaranteed Minimum; 1280 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

0117 Mental Health Group Counseling (6020)

90 Units Guaranteed Minimum; 1800 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

90 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0118 Mental Health Relationship and Parenting Counseling (6031)

2 Units Guaranteed Minimum; 100 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

0119 MH - Medication Monitoring & Report (6051)

2 Units Guaranteed Minimum; 150 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

0120 Sex Offender Intake Assessment & Report (5012)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Option Year 4: 49 months through 60 months

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QUANTITY

UNIT UNIT PRICE AMOUNT

0121 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

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

0122 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 20 Units Estimated Maximum

Option Year 4: 49 months through 60 months

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0123 Sex Offender Individual Counseling (6012)

20 Units Guaranteed Minimum; 620 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

0124 Sex Offender Group Counseling (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.

QUANTITY

UNIT UNIT PRICE AMOUNT

0125 Sex Offender Relationship and Parenting Counseling (6032)

2 Units Guaranteed Minimum; 48 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

0126 Substance Use Disorder Treatment Planning and Follow-up (2001)

8 Units Guaranteed Minimum; 38 Units Estimated Maximum

Potential 6 Month Extension

8 EA $________ $_________________

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QUANTITY

UNIT UNIT PRICE AMOUNT

0127 Substance Use Disorder Intake Screening (2005)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0128 Substance Use Disorder Individual Counseling (2010)

50 Units Guaranteed Minimum; 1200 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

50 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0129 Substance Use Disorder Intake Assessment & Report (2011)

8 Units Guaranteed Minimum; 38 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

8 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0130 Co-occurring Intake Assessment & Report (2012)

3 Units Guaranteed Minimum; 25 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0131 Substance Use Disorder Group Counseling (2020)

60 Units Guaranteed Minimum; 1980 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

60 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0132 Substance Use Disorder Relationship and Parenting Counseling (2030)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

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QUANTITY

UNIT UNIT PRICE AMOUNT

0133 MAT – Follow-Up & Report (4004)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0134 MAT - Intake Screening (4005)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0135 MAT Psychiatric Evaluation & Report (4050)

1 Unit Guaranteed Minimum; 25 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0136 Mental Health Treatment Planning and Follow-up (5001)

3 Units Guaranteed Minimum; 38 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0137 Mental Health Intake Screening (5005)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0138 Mental Health Intake Assessment & Report (5011)

3 Units Guaranteed Minimum; 38 Units Estimated Maximum

Potential 6 Month Extension

3 EA $________ $_________________

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QUANTITY

UNIT UNIT PRICE AMOUNT

0139 Psychiatric Evaluation & Report (5030)

3 Units Guaranteed Minimum; 38 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

3 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0140 Crisis Intervention Evaluation & Report (6000)

1 Unit Guaranteed Minimum; 5 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0141 Mental Health Individual Counseling (6010)

10 Units Guaranteed Minimum; 640 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0142 Mental Health Group Counseling (6020)

45 Units Guaranteed Minimum; 900 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

45 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0143 Mental Health Relationship and Parenting Counseling (6031)

1 Unit Guaranteed Minimum; 50 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0144 MH - Medication Monitoring & Report (6051)

1 Unit Guaranteed Minimum; 75 Units Estimated Maximum

Potential 6 Month Extension

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QUANTITY

UNIT UNIT PRICE AMOUNT

0145 Sex Offender Intake Assessment & Report (5012)

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

0146 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)

1 Unit Guaranteed Minimum; 13 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0147 Sex Offender Intake Screening (6005)

1 Unit Guaranteed Minimum; 10 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

1 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0148 Sex Offender Individual Counseling (6012)

10 Units Guaranteed Minimum; 310 Units Estimated Maximum

Potential 6 Month Extension

PSC: G004

10 EA $________ $_________________

ITEM NO. SUPPLIES/SERVICES EST.

QUANTITY

UNIT UNIT PRICE AMOUNT

0149 Sex Offender Group Counseling (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

0150 Sex Offender Relationship and Parenting Counseling (6032)

1 Unit Guaranteed Minimum; 24 Units Estimated Maximum

Potential 6 Month Extension

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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 (Dec 2022)

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)

15BCTS23Q00000017 Page 30 of 70

(a))Melissa Acevedo, Lead COR, Stephanie Hamilton, Michelle Blake, Rick Dooley, Tesia Easley, Lindsey Martin, Lashanda Williams, Misty Hoffer, and Caitlin Wilbanks ,Kansas City Office , 400 State Avenue, Tower II, 6th Floor Kansas City, KS 66101,913-551-1155, 913-551-8322, 913-551-1112, 913-551-1063, 913-551-1037, 913-551-1086, 913-551-8322, 913-551-1087, and 913-551-1081 , 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.

III. Confidentiality and Non-disclosure of DOJ Information

15BCTS23Q00000017 Page 31 of 70

A. Preliminary and…