SOW Template_FINAL.doc
DOC document 71 KB Posted
- Attached to
- Technology Based Behavioral Health Services
- Contract number
- PRF80
- Issued by
- Massachusetts
About this file
This document is a Statement of Work (SOW) template for a Massachusetts Statewide Contract designated as PRF80, specifically focused on Technology-Based Behavioral Health Services. The contract is issued by the Commonwealth of Massachusetts and is designed to be used by state institutions and buyers who can reference the "PRF80 RFQ" to receive contract pricing through the COMMBUYS procurement platform.
The SOW outlines a comprehensive range of behavioral health services including 24x7x365 triage, screening and assessment, crisis counseling, individual and group therapy, community support referrals, outreach, and maintenance of a mobile-friendly application. The contract appears to have a service period not exceeding July 31, 2022, with provisions for new engagements or continuations. While specific budget details are not fully disclosed, the template includes sections for capturing total budget amounts, and allows for amendments to scope and terms with written agreement from both parties. The contract includes termination clauses that permit the Department to end the engagement under various circumstances, including lack of funding or breach of contract terms.
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Commonwealth of Massachusetts Statewide Contract, PRF80: Technology-Based Behavioral Health Services Statement of Work Template
Buyers should review the Contract User Guide (CUG) for guidance on how to purchase from PRF80 and Appendix B, Statement of Work Guidance for IPEH.
SELECT ALL APPLICABLE SERVICES FOR THIS ENGAGEMENT
FORMCHECKBOX
PRF80 Access to 24x7x365 triage to identify service and appropriate response
FORMCHECKBOX
PRF80 Screening and assessment to identify treatment need
FORMCHECKBOX
PRF80 Brief crisis counseling
FORMCHECKBOX
PRF80 Short term treatment through individual therapy, group therapy, and/or other means of providing counseling services
FORMCHECKBOX
PRF80 Support and referral to other community supports (e.g. 12-step programs, peer groups, etc.)
FORMCHECKBOX
PRF80 Referrals and bridge services to longer term treatment
FORMCHECKBOX
PRF80 Outreach and marketing to raise awareness of services and incentivize engagement, informed by student feedback
FORMCHECKBOX
PRF80 Maintenance and support of a Mobile-friendly application providing access to services as well as general wellness information
PRF80 COMMBUYS bid # or bid description (if applicable):
Buyers should reference “PRF80 RFQ” to receive contract pricing.
FORMCHECKBOX
New FORMCHECKBOX Continuation *Anticipated Effective Date of Amendment:
Institution Name:
Dates of Service: New *Anticipated Start Date: End Date:_ _
End date Not to exceed July 31,2022 Continuation Original Start Date: Current End Date:
New End Date:
End date Not to exceed July 31,2022
Scope of Services: FORMCHECKBOX See Narrative below FORMCHECKBOX Attachment provided For Continuation ONLY: FORMCHECKBOX Scope of Services amended FORMCHECKBOX No Change to Scope of Services
Pricing information: Choose One
FORMCHECKBOX
Budget attached for duration less than or equal to 12 months
New Total budget for engagement $
Continuation
Current Total budget for engagement $ Amendment Amount (+ or -) for engagement $ New Total budget for engagement $
Changes to Scope and/or Terms: Any changes to this engagement must be agreed upon in writing in advance by both parties.
Termination: The Department, upon prior written notice, may terminate this engagement without cause and without penalty, or may terminate or suspend an engagement if the vendor breaches any material term or condition or fails to perform or fulfill any material obligation required by this engagement, or in the event of an elimination of an appropriation or absence of sufficient funds for the purposes of an engagement, or in the event of an unforeseen public emergency mandating immediate department action.
Authorizing Signature for the Vendor
Authorized Vendor Signature and Date
Print Name and Title
Authorizing Signatures for the Department
Authorized Signature and Date
Print Name and Title
*The effective start date of this Engagement or Amendment shall be the latest date this document has been executed by an authorized signatory of the Vendor, the Department or a later Engagement or Amendment start date specified above.
Issued 4/13/2012
File details come from the government source that posted it. Updated .