Solicitation 15BCTS23Q00000019.pdf
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- 15BCTS23Q00000019 - SU/MH/SOT/MAT in Waco, TX Federal contract opportunity
- Solicitation number
- 15BCTS23Q00000019
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| File | Type | Posted |
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| Cover Letter.pdf | ||
| Technical Quotation Information Packet.docx | DOCX document | |
| Section 2.1, Continuation SF-1449.pdf | ||
| 2022 Statement of Work (SOW).pdf | ||
| Whistleblower Information.pdf | ||
| Business Quotation Information Packet.pdf |
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15BCTS23Q00000019 Page 1 of 70
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES
NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 AND 30.
1. REQUISITION NUMBER PAGE 1 OF
5. SOLICITATION NUMBER
15BCTS23Q00000019
2. CONTRACT NUMBER 3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER 6. SOLICITATION ISSUE
DATE
04/24/2023
7. FOR SOLICITATION
INFORMATION CALL:
a. NAME
Joo Walker j15walker@bop.gov
b. TELEPHONE NUMBER (No collect calls)
(202) 451-7924
8. OFFER DUE DATE / LOCAL
TIME
05/12/2023 12:00 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:100.00 % FOR
X SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL BUSINESS
(EDWOSB)
8(A)
NORTH AMERICAN
INDUSTRY CLASSIFICATION
STANDARD (NAICS):
621420
SIZE STANDARD:
$19,000,000
10. THE ACQUISITION IS
SEE SCHEDULE
11. DELIVERY FOR FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER THE
DEFENSE PRIORITIES AND
ALLOCATIONS SYSTEM -
DPAS (15 CFR 700)
13b. RATING
X REQUEST
FOR QUOTE
(RFQ)
INVITATION
FOR BID
(IFB)
REQUEST
FOR
PROPOSAL
(RFP)
14. METHOD OF SOLICITATION
15B500CODE15. DELIVER TO
Federal Bureau of Prisons South Central Regional Office 344 Marine Forces Drive Grand Prairie, TX 75051
CODE 15BCTS16. ADMINISTERED BY
Federal Bureau of Prisons Community Treatment Services Contracting 320 First Street NW, Suite 901-5 Washington, DC 20534
Joo Walker
(O) 202-451-7924 j15walker@bop.gov
FACILITY
CODE
CODE
TELEPHONE NUMBER
17a. CONTRACTOR/
OFFEROR
15B500CODE18a. PAYMENT WILL BE MADE BY
Federal Bureau of Prisons South Central Regional Office 344 Marine Forces Drive Grand Prairie, TX 75051
BOP-RSD-CRBCTS-BILL-DAL@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 NUMBER
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
Delivery Date: 07/01/2023
Substance Use, Mental Health, Sex Offender and Medication Assisted Treatment Services in Waco, Texas 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 Government Use Only)
X 27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3
AND 52.212-5 ARE ATTACHED. ADDENDA
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: REFERENCE _____________________________
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)
Joo Walker
31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 11/2021)
Prescribed by GSA - FAR (48 CFR) 53.212
019-23
15BCTS23Q00000019 Page 2 of 70
19.
ITEM NUMBER
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. 11/2021) BACK
15BCTS23Q00000019 Page 3 of 70
Table of Contents
Section Description Page Number
Solicitation/Contract Form 1 Commodity or Services Schedule 2 Contract Clauses
DJAR-PGD-15-03 Security of Department Information and Systems DOJ-05 Security of Department Information and Systems (APR 2015) 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)
BOP 2852.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR
2011) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) DOJ-03 Personnel Security Requirements For Contractor Employees (Nov 2021) DOJ-01 Whistleblower Information Distribution (Oct 2021) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) 52.216-22 Indefinite Quantity (Oct 1995) 52.203-17 Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights (Jun 2020) 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.216-18 Ordering (Aug 2020) DOJ-02 Contractor Privacy Requirements (JAN 2022) 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 (Mar 2023)
3.1 Instructions to Offerors - Commercial Services
52.242-15 Stop-Work Order (Aug 1989) 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (Dec 2022) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.253-1 Computer Generated Forms (Jan 1991) 52.203-3 Gratuities (Apr 1984) 52.203-12 Limitation On Payments to Influence Certain Federal Transactions (Jun 2020) 52.204-12 Unique Entity Identifier Maintenance (Oct 2016) 52.242-13 Bankruptcy (July 1995) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) 52.204-13 System for Award Management Maintenance (Oct 2018)
3 List of Attachments 4 Solicitation Provisions
52.216-1 Type of Contract (Apr 1984) 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (Mar 2023) 52.217-5 Evaluation of Options (July 1990)
15BCTS23Q00000019 Page 4 of 70
Section 1 - 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)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0002 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0003 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0004 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
15BCTS23Q00000019 Page 5 of 70
0005 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0006 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0007 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0008 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0009 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
15BCTS23Q00000019 Page 6 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0010 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0011 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0012 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 35
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0013 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0014 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
5 EA $________ $_________________
15BCTS23Q00000019 Page 7 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0015 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0016 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0017 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0018 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0019 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Base Period: 1 month through 12 months
15BCTS23Q00000019 Page 8 of 70
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0020 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0021 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0022 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0023 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 620
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0024 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 960
4 EA $________ $_________________
15BCTS23Q00000019 Page 9 of 70
Base Period: 1 month through 12 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0025 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0026 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0027 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0028 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
0029 Co-occurring Intake Assessment & Report (2012) 5 EA $________ $_________________
15BCTS23Q00000019 Page 10 of 70
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0030 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0031 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0032 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0033 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000019 Page 11 of 70
0034 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0035 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0036 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 35
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0037 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0038 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
15BCTS23Q00000019 Page 12 of 70
QUANTITY
UNIT UNIT PRICE AMOUNT
0039 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0040 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0041 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0042 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0043 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total
15BCTS23Q00000019 Page 13 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0044 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0045 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0046 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0047 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 620
Option Year 1: 13 months through 24 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0048 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 960
Option Year 1: 13 months through 24 months
15BCTS23Q00000019 Page 14 of 70 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0049 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0050 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0051 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0052 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0053 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
15BCTS23Q00000019 Page 15 of 70
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0054 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0055 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0056 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0057 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
0058 MAT Psychiatric Evaluation & Report (4050) 2 EA $________ $_________________
15BCTS23Q00000019 Page 16 of 70
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0059 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0060 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 35
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0061 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0062 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000019 Page 17 of 70
0063 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0064 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0065 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0066 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0067 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
15BCTS23Q00000019 Page 18 of 70
QUANTITY
UNIT UNIT PRICE AMOUNT
0068 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0069 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0070 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0071 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 620
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0072 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 960
Option Year 2: 25 months through 36 months
Use the Guaranteed Minimum Quantity when developing the total
15BCTS23Q00000019 Page 19 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0073 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0074 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0075 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0076 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0077 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 3: 37 months through 48 months
15BCTS23Q00000019 Page 20 of 70 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0078 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0079 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0080 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0081 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0082 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
15BCTS23Q00000019 Page 21 of 70
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0083 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0084 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 35
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0085 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0086 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
0087 Crisis Intervention Evaluation & Report (6000) 1 EA $________ $_________________
15BCTS23Q00000019 Page 22 of 70
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0088 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0089 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0090 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0091 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000019 Page 23 of 70
0092 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0093 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0094 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0095 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 620
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0096 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 960
Option Year 3: 37 months through 48 months
Use the Guaranteed Minimum Quantity when developing the total amount.
15BCTS23Q00000019 Page 24 of 70
QUANTITY
UNIT UNIT PRICE AMOUNT
0097 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0098 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0099 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1200
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0100 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 12 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
12 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0101 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total
15BCTS23Q00000019 Page 25 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0102 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 120 Estimated Maximum Quantity: 3960
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
120 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0103 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0104 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0105 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0106 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 50
Option Year 4: 49 months through 60 months
15BCTS23Q00000019 Page 26 of 70 amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0107 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0108 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 35
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0109 Mental Health Intake Assessment & Report (5011)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0110 Psychiatric Evaluation & Report (5030)
Guaranteed Minimum Quantity: 5 Estimated Maximum Quantity: 75
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
5 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0111 Crisis Intervention Evaluation & Report (6000)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 10
1 EA $________ $_________________
15BCTS23Q00000019 Page 27 of 70
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0112 Mental Health Individual Counseling (6010)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 2400
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0113 Mental Health Group Counseling (6020)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0114 Mental Health Relationship and Parenting Counseling (6031)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 100
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0115 MH - Medication Monitoring & Report (6051)
Guaranteed Minimum Quantity: 2 Estimated Maximum Quantity: 150
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
2 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0116 Sex Offender Intake Assessment & Report (5012)
Guaranteed Minimum Quantity: 1
15BCTS23Q00000019 Page 28 of 70
Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0117 Sex Offender Treatment Disorder Treatment Planning and Follow-up (6001)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0118 Sex Offender Intake Screening (6005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 20
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0119 Sex Offender Individual Counseling (6012)
Guaranteed Minimum Quantity: 20 Estimated Maximum Quantity: 620
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
20 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0120 Sex Offender Group Counseling (6022)
Guaranteed Minimum Quantity: 4 Estimated Maximum Quantity: 960
Option Year 4: 49 months through 60 months
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
4 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
15BCTS23Q00000019 Page 29 of 70
0121 Substance Use Disorder Treatment Planning and Follow-up (2001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0122 Substance Use Disorder Intake Screening (2005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0123 Substance Use Disorder Individual Counseling (2010)
Guaranteed Minimum Quantity: 30 Estimated Maximum Quantity: 600
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
30 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0124 Substance Use Disorder Intake Assessment & Report (2011)
Guaranteed Minimum Quantity: 6 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
6 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0125 Co-occurring Intake Assessment & Report (2012)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
3 EA $________ $_________________
15BCTS23Q00000019 Page 30 of 70
QUANTITY
UNIT UNIT PRICE AMOUNT
0126 Substance Use Disorder Group Counseling (2020)
Guaranteed Minimum Quantity: 60 Estimated Maximum Quantity: 1980
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
60 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0127 Substance Use Disorder Relationship and Parenting Counseling (2030)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0128 MAT – Follow-Up & Report (4004)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 50
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0129 MAT - Intake Screening (4005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 13
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0130 MAT Psychiatric Evaluation & Report (4050)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 25
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total
15BCTS23Q00000019 Page 31 of 70
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0131 Mental Health Treatment Planning and Follow-up (5001)
Guaranteed Minimum Quantity: 3 Estimated Maximum Quantity: 38
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
3 EA $________ $_________________
ITEM NO. SUPPLIES/SERVICES EST.
QUANTITY
UNIT UNIT PRICE AMOUNT
0132 Mental Health Intake Screening (5005)
Guaranteed Minimum Quantity: 1 Estimated Maximum Quantity: 18
Potential 6 Month Extension
Use the Guaranteed Minimum Quantity when developing the total amount.
PSC: G004
1 EA $________ $_________________
ITEM…
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