Logo
 

Master Blanket Purchase Order ADCS14-074620

Header Information
Purchase Order Number: ADCS14-074620 Release Number: 0 Short Description: Family Support, Preservation and Reunification Services (In Home Services Program) - Central Region
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: OP2 - Purchasing Type Code:
Alternate ID: Entered Date: 06/27/2014 09:19:51 AM 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: Tracy Chisler - 602-255-2863 or Tracy.Chisler@AZDCS.GOV Tax Rate: Actual Cost: $12,034.00
Master Blanket/Contract End Date (Maximum): 03/31/2018 10:47:00 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 05 DES Special Terms and Conditions~39.pdf Attachment 01 Definitions.pdf Exhibit A1 Referral~1.doc Exhibit A2 Referral for Clinical Family Assessment~1.doc Exhibit C Initial Interim Plan(eform)~1.doc Exhibit D Clinical Family Assessment~1.doc Exhibit E Protective Factors Survey~1.pdf Exhibit F Monthly Progress Report(eform)~1.doc Exhibit G Weekly Progress Report(eform)~1.doc Exhibit H Emergency Funds Authority Form(eform)~1.doc Exhibit I Extension Approval Form(eform)~1.doc Exhibit J Discharge Summary(eform)~1.doc Exhibit K Pandemic Planning Checklist~1.pdf Exhibit M Data Sharing Request Agreement~1.pdf Exhibit B No Contact Form(eform)~8.doc 04 Scope of Work~37.pdf Signed Offer and Acceptance~12.pdf BAFO Attachment 02 Service Implimentation Questionnaire.pdf BAFO Attachment 03 Brief Summary.pdf BAFO Attachment 04 Organization Chart SWHD.pdf BAFO Attachment 04 PSP Organization Chart.pdf BAFO Attachment 04 Staff Organization Chart CCC.pdf BAFO Attachment 04 Staff Organization Chart HRT.pdf BAFO Attachment 04 Staff Organization Chart JFCS.pdf BAFO Attachment 04 Staff Organization Chart ROP.pdf BAFO Attachment 05 JFCS Director of Homebased Services.pdf BAFO Attachment 05 JFCS Program Manager.pdf BAFO Attachment 05 JFCS Supervisor.pdf BAFO Attachment 05 ROP Family Support Worker.pdf BAFO Attachment 05 ROP Program Coordinator.pdf BAFO Attachment 05 CCC Resource Specialist.pdf BAFO Attachment 05 HRT Clinical Director.pdf BAFO Attachment 05 HRT Clinician.pdf BAFO Attachment 05 HRT Family Support Worker.pdf BAFO Attachment 05 HRT Peer Mentor.pdf BAFO Attachment 05 HRT Program Director.pdf BAFO Attachment 05 HRT Team Lead.pdf BAFO Attachment 05 JFCS Family Support Worker.pdf BAFO Attachment 05 JFCS Team Lead.pdf BAFO Attachment 05 ROP Team Lead.pdf BAFO Attachment 05 SWHD Nurse Consultant.pdf BAFO Attachment 06 Facility Location and Staffing.pdf BAFO Attachment 07 Management Letter and Auditors Opinion.pdf BAFO Attachment 09 Written Assurance.pdf BAFO Attachment 10 CCC Insurance Ability Letter.pdf BAFO Attachment 10 HRT Insurance Ability 1.pdf BAFO Attachment 10 HRT Insurance Ability Letter 2.pdf BAFO Attachment 10 HRT Insurance Ability Letter 3.pdf BAFO Attachment 10 HRT Insurance Ability Letter 4.pdf BAFO Attachment 10 HRT Insurance Ability Letter 5.pdf BAFO Attachment 10 JFCS Insurance Ability.pdf BAFO Attachment 10 ROP Inusrance Ability Letter.pdf BAFO Attachment 10 SWHD Insurance Ability Letter.pdf BAFO Attachment 11 Certification Regarding Lobbyin1.pdf BAFO Attachment 12 Certification Regarding Debarment.pdf BAFO Attachment 13 Sole Proprietor Waiver~2.pdf BAFO Attachment 14 Arizona Substitute W-9.pdf Signed Business Associate Agreement.pdf BAFO Evaluation HUMAN RESOURCE TRAINING INC.pdf Evaluations Non Awarded (zipped) Folder~5.zip Notification Lifting Stay of Procurement 6-7-2012~3.pdf Attachment Extension-Address Change-Central Registry-Address Confidentiality~7.pdf Attachment Extension-Address Change-Central Registry-Address Confidentiality~8.pdf CHANGE ORDER 9 - AMENDMENT 7~5.pdf Assignment Change Order ADCS14-074620 Change Order 1 Amendment 1.doc ADCS14-074620 Amendment 2 CO 3.pdf ADCS14-074620 Certificate of Insurance 01-12-16.pdf ADCS14-074620 COI Exp 4-1-17 ADCS14-074620 Boycott of Israel Notification.pdf ADCS14-074620 Amendment 3.pdf Human Resource Training Amendment 4.pdf Contract Amendment 5 ADCS14-074620.pdf ADCS14-074620 Amendment 5.pdf Contract Amendment 06~4.zip Contract Amendment 7 Human Resource Training Contract Amendment 8.pdf CI Determination - Family Support-Pres-Reunification In-Home~1.pdf
Vendor Attachments:
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 9000003698 - HUMAN RESOURCE TRAINING INC
Cecilia D Jones
1951 W Camelback Rd
Suite 450
Phoenix, AZ 85015
US
Email: contracts@hrtaz.com
Phone: (602)433-1344
FAX: (602)249-1570
Alt. Reference: Z0002
Payment Terms: Net 30 Shipping Method:
Shipping Terms: Freight Terms:
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to contracts@hrtaz.com at 12/26/2014 04:46:22 PM 12/29/2014 12:50:18 PM
Change Order 1 Emailed to contracts@hrtaz.com at 03/20/2015 09:21:23 AM 03/23/2015 10:21:37 AM
Change Order 2 Emailed to contracts@hrtaz.com at 01/05/2016 02:21:48 PM 01/05/2016 11:10:53 PM
Change Order 3 Emailed to contracts@hrtaz.com at 01/13/2016 11:57:33 AM 01/13/2016 12:56:00 PM
Change Order 4 Emailed to contracts@hrtaz.com at 03/30/2016 08:08:22 AM 03/30/2016 11:59:36 AM
Change Order 5 Emailed to contracts@hrtaz.com at 01/25/2017 01:57:18 PM 01/25/2017 02:36:32 PM
Change Order 6 Emailed to contracts@hrtaz.com at 02/28/2017 08:40:58 AM 03/03/2017 12:15:51 PM
Change Order 7 Emailed to contracts@hrtaz.com at 05/04/2017 12:49:32 PM 05/08/2017 01:03:38 PM
Change Order 8 Emailed to contracts@hrtaz.com at 08/08/2017 12:21:59 PM 08/08/2017 01:21:36 PM
Change Order 9 Emailed to contracts@hrtaz.com at 12/27/2017 10:53:57 AM 12/28/2017 04:00:30 PM
Change Order 10 Emailed to contracts@hrtaz.com at 03/13/2018 02:12:01 PM 03/13/2018 03:09:42 PM
Change Order 11 Emailed to contracts@hrtaz.com at 05/17/2018 10:57:57 AM 05/17/2018 01:21:33 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
9000003698
PZ9000003698 HUMAN RESOURCE TRAINING INC Email Active
Master Blanket/Contract Controls
Master Blanket/Contract Begin Date: 01/01/2015 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   
1-5 of 7
1 2 
Print Sequence # 1.0, Item # 3:   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 $4,300.00 EA - Each 0.00 $0.00 $0.00 $4,300.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 2.0, Item # 4:   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 $3,100.00 EA - Each 0.00 $0.00 $0.00 $3,100.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 3.0, Item # 5:   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 $3,700.00 EA - Each 0.00 $0.00 $0.00 $3,700.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 4.0, Item # 6:   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 $70.00 HR - Hour 0.00 $0.00 $0.00 $70.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 1:   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 $70.00 HR - Hour 0.00 $0.00 $0.00 $70.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
1-5 of 7
1 2 
Copyright © 2018 Periscope Holdings, Inc. - All Rights Reserved. AZ-PAS4