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Master Blanket Purchase Order ADCS14-074338

Header Information
Purchase Order Number: ADCS14-074338 Release Number: 0 Short Description: Family Support, Preservation and Reunification Services (In Home Services Program) Central Reg
Status: 3PS - Sent Purchaser: Tracy Chisler Receipt Method: Quantity
Fiscal Year: 2015 PO Type: Blanket Minor Status:
Organization: Arizona Department of Child Safety
Department: OP - Office of Procurement Location: OP - Contracts Type Code:
Alternate ID: Entered Date: 06/21/2014 04:29:11 PM Control Code:
Days ARO: 0 Retainage %: 0.00% Discount %: 0.00%
Print Dest Detail: If Different
Catalog ID: Release Type: Direct Release Pcard Enabled: No
Contact Instructions: Tax Rate: Actual Cost: $12,771.00
Master Blanket/Contract End Date (Maximum): 03/31/2018 11:20:00 AM
Project No.:
Special Purchase Types: Competition Impracticable
PIJ NUMBER:
Commodity Reference Id:
PO External Doc Type:
Agency Attachments: 03 Uniform Terms and Conditions~22.pdf BAFO Attachment 05 Job Description Nurse Practitioner or Physician Assistant In-home Services TERROS.pdf BAFO Attachment 05 Job Description Regional Supervisor TERROS.pdf BAFO Attachment 05 Job Description Subcontractor Family Support Worker.pdf BAFO Attachment 05 Job Description Subcontractor Team Lead - FP.pdf BAFO Attachment 05 Job Description Vice President of Families FIRST and In-home Services TERROS.pdf BAFO Attachment 06 Facility Location and Staffing Chart~1.pdf BAFO Attachment 07 Management Letter and Auditors Opinion~2.pdf BAFO Attachment 09 Written Assurance~2.pdf BAFO Attachment 10 Insurance Ability Letter~2.pdf BAFO Attachment 11 Certification of Lobbying.pdf BAFO Attachment 12 Certification Regarding Debarment~3.pdf BAFO Attachment 05 Job Description In-home family Therapist Team Lead TERROS .pdf BAFO Attachment 05 Job Description Family Support Worker TERROS.pdf Signed Business Associates Agreement~1.pdf BAFO Attachment 05 Job Description Director of In-home Services TERROS.pdf BAFO Attachment 05 Job Description Peer Mentor TERROS.pdf BAFO Attachment 04 Staff Organization Chart.pdf BAFO Attachment 03 Brief Summary~2.pdf BAFO Attachment 02 Service Implementation Questionnaire TERROS - Central.pdf Signed Offer and Acceptance~14.pdf 04 Scope of Work~37.pdf Change Order 1 - Amendment 1.pdf Exhibit B No Contact Form(eform)~8.doc Exhibit M Data Sharing Request Agreement~1.pdf Exhibit K Pandemic Planning Checklist~1.pdf Exhibit J Discharge Summary(eform)~1.doc Exhibit I Extension Approval Form(eform)~1.doc Exhibit H Emergency Funds Authority Form(eform)~1.doc Exhibit G Weekly Progress Report(eform)~1.doc Exhibit F Monthly Progress Report(eform)~1.doc Exhibit E Protective Factors Survey~1.pdf Exhibit D Clinical Family Assessment~1.doc Exhibit C Initial Interim Plan(eform)~1.doc Exhibit A2 Referral for Clinical Family Assessment~1.doc Exhibit A1 Referral~1.doc Attachment 01 Definitions.pdf 05 DES Special Terms and Conditions~39.pdf BAFO Attachment 13 Sole Proprietor Waiver~4.pdf BAFO Attachment 14 Arizona Substitute W-9~2.pdf BAFO Evaluation TERROS INC.pdf Evaluations Non Awarded (zipped) Folder~8.zip Notification Lifting Stay of Procurement 6-7-2012~2.pdf Attachment Extension-Central Registry-Address Confidentiality~14.pdf Boycott Israel Notification ADCS14-074338.pdf Amendment 3 ADCS14-074338.pdf Contractors COI Exp 10-1-17 ADCS14-074338.pdf CHANGE ORDER 9 - AMENDMENT 7~1.pdf Contract Amendment 5 ADCS14-074338.pdf Contract Amendment 06~2.zip Change Order 10 - Amendment 8~5.pdf Assignment Change Order Change Order 2 - Amendment 2~1.pdf Contract Amendment 4 ADCS14-074338.pdf Contract Amendment 7 Terros_Contract Amendment 8.pdf
Vendor Attachments:
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 000002674 - TERROS INC
Debbie Tinsley
3003 N. Central Ave., Suite 200
Phoenix, AZ 85012
US
Email: Kate.Demboski@terros.org
Phone: (602)685-6000
FAX: (602)265-6973
Website: http://www.terros.org
Alt. Reference: Z0001
Payment Terms: TBD Shipping Method:
Shipping Terms: Freight Terms: Freight Prepaid
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to Kate.Demboski@terros.org at 02/02/2015 04:41:11 PM
Change Order 1 Emailed to Kate.Demboski@terros.org at 03/13/2015 06:37:56 PM 05/08/2015 01:45:41 PM
Change Order 2 Emailed to Kate.Demboski@terros.org at 03/18/2016 01:09:54 PM 03/18/2016 03:29:18 PM
Change Order 3 Emailed to Kate.Demboski@terros.org at 02/21/2017 12:36:46 PM
Change Order 4 Emailed to Kate.Demboski@terros.org at 05/04/2017 12:45:02 PM
Change Order 5 Emailed to Kate.Demboski@terros.org at 08/10/2017 10:23:58 AM 08/28/2017 10:53:54 AM
Change Order 6 Emailed to Kate.Demboski@terros.org at 12/21/2017 04:10:36 PM
Change Order 7 Emailed to Kate.Demboski@terros.org at 03/13/2018 04:13:08 PM 04/02/2018 07:55:21 AM
Change Order 8 Emailed to Kate.Demboski@terros.org at 05/17/2018 10:55:29 AM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
000002674
PZ000002674 TERROS INC Email Active
Master Blanket/Contract Controls
Master Blanket/Contract Begin Date: 02/06/2015 Master Blanket/Contract End Date: 07/31/2018
Cooperative Purchasing Allowed: Yes
Organization Department Dollar Limit Dollars Spent to Date Minimum Order Amount
ADCS - Arizona Department of Child Safety AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
ADES - Arizona Department of Economic Security AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
Item Information   
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Print Sequence # 1.0, Item # 1:   One (1) Intensive Services Case Rate: The Intensive case rate payment points are described in Section 6.1 of the Scope of Work: 3PS - Sent
NIGP Code: 952-74
   Family Support, Preservation and Reunification : HP15-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $4,653.00 EA - Each 0.00 $0.00 0.000% $0.00 $4,653.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 2.0, Item # 2:   One (1) Moderate Services Case Rate: The Moderate case rate payment points are described in Section 6.2 of the Scope of Work: 3PS - Sent
NIGP Code: 952-74
   Family Support, Preservation and Reunification : HP15-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $3,526.00 EA - Each 0.00 $0.00 0.000% $0.00 $3,526.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 3.0, Item # 3:   One (1) Reunification and Placement Stabilization Services Case Rate: The Reunification and Placement Stabilization case rate payment points are described in Section 6.3 of the Scope of Work: 3PS - Sent
NIGP Code: 952-74
   Family Support, Preservation and Reunification : HP15-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $4,216.00 EA - Each 0.00 $0.00 0.000% $0.00 $4,216.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 4.0, Item # 4:   One (1) Family Support Services Payment Rate/One (1) Hour of Family Support: As described under Section 6.4.1 of the Scope of Work. 3PS - Sent
NIGP Code: 952-74
   Family Support, Preservation and Reunification : HP15-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $86.00 HR - Hour 0.00 $0.00 0.000% $0.00 $86.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 5:   One (1) Family Support Services Payment Rate/One (1) Hour of Consultation: As described under Section 6.4.2 of the Scope of Work. 3PS - Sent
NIGP Code: 952-74
   Family Support, Preservation and Reunification : HP15-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $86.00 HR - Hour 0.00 $0.00 0.000% $0.00 $86.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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