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Master Blanket Purchase Order ADCS16-119241

Header Information
Purchase Order Number: ADCS16-119241 Release Number: 0 Short Description: Counseling & Consultation Services
Status: 3PS - Sent Purchaser: Delilah Gonzalez Receipt Method: Quantity
Fiscal Year: 2016 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: 12/24/2015 09:22:07 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: Delilah Gonzalez at 602-255-2887 or Delilah.Gonzalez@azdcs.gov Tax Rate: Actual Cost: $592.00
Master Blanket/Contract End Date (Maximum): 12/31/2020 11:59:59 PM
Project No.:
Special Purchase Types:
PIJ NUMBER:
Commodity Reference Id:
PO External Doc Type:
Agency Attachments: 01 Pre-solicitation Documents.zip 02 Solicitation Documents.zip Determination for MultiAgency Contracts for Psychiatric_Psychological_Counseling Services Counseling_Consultation Services RFP rev 10-21-15 Counseling RFP Exhibits and Forms~24.zip Signed HITECH HIPPA Form Signed Offer and Acceptance Family Strategies and Coaching_Award Letter Family Strategies - Amendment 1.docx Family Strategies - Facility License Renewal.pdf Family Strategies - Professional License Renewal.pdf Family Strategies COI (Pro) exp. 4-03-17.pdf Family Strategies COI (WC) exp. 9-21-17.pdf Family Strategies COI (GL) exp. 1-01-18.pdf Contract Amendment 2~34.zip Contract Amendment 3~57.zip
Vendor Attachments: Signed Offer and Acceptance Form Attachment 1 - ADCS Qualified Contractor Application Attachment 2 - List of References Attachment 3 - Licensure-Certification Attestation Attachment 4 - Copy of Professional License Sole Proprietor Waiver Independent Contractor Agreement Arizona Substitute W-9 Designation of Confidential, Trade Secret & Proprietary Information HITECH Business Associate Agreement
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 000028113 - Family Strategies & Coaching
Floyd Godfrey
6402 E Superstition Springs Blvd Ste 208
Mesa, AZ 85206
US
Email: fgodfrey@familystrategies.org
Phone: (480)668-8301
FAX: (480)558-3020
Alt. Reference: Z0001
Payment Terms: Net 30 Shipping Method: Best Way
Shipping Terms: Cost, Insurance and Freight Freight Terms: Freight Allowed
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to fgodfrey@familystrategies.org at 01/05/2016 10:02:25 AM 01/06/2016 11:04:57 AM
Change Order 1 Emailed to fgodfrey@familystrategies.org at 01/09/2016 06:28:41 AM 01/11/2016 01:25:05 PM
Change Order 2 Emailed to fgodfrey@familystrategies.org at 12/14/2016 03:47:36 PM
Change Order 3 Emailed to fgodfrey@familystrategies.org at 12/18/2017 03:32:38 PM 12/21/2017 11:23:50 AM
Change Order 4 Emailed to fgodfrey@familystrategies.org at 09/24/2018 03:59:49 PM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
000028113
PZ000028113 Family Strategies & Coaching Email Active
Master Blanket/Contract Controls
Master Blanket/Contract Begin Date: 01/01/2016 Master Blanket/Contract End Date: 12/31/2019
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
ADJC - Arizona Department of Juvenile Corrections AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
Item Information   
Print Sequence # 1.0, Item # 1:   One (1) Hour Consultation - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 1 Quote # / Quote Item #:  000035853-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $105.00 HR - Hour 0.00 $0.00 $0.00 $105.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 2:   One (1) Therapy Hour of Individual and/or Family Counseling: Office Setting - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 5 Quote # / Quote Item #:  000035853-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $105.00 HR - Hour 0.00 $0.00 $0.00 $105.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 6.0, Item # 5:   One (1) Therapy Hour of Individual and/or Family Counseling: Home Based - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $130.00 HR - Hour 0.00 $0.00 $0.00 $130.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 9.0, Item # 3:   One (1) Group Counseling Session - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 9 Quote # / Quote Item #:  000035853-R1 / 9
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $52.00 EA - Each 0.00 $0.00 $0.00 $52.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 11.0, Item # 4:   One (1) Completed Clinical Family Assessment Report - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 11 Quote # / Quote Item #:  000035853-R1 / 11
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $200.00 EA - Each 0.00 $0.00 $0.00 $200.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
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