Logo
 

Master Blanket Purchase Order ADCS16-119245

Header Information
Purchase Order Number: ADCS16-119245 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 Delilah.Gonzalez@azdcs.gov Tax Rate: Actual Cost: $1,212.00
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~39.zip Signed HITECH HIPPA Form Signed Offer and Acceptance Lifeline PCS_Award Letter Lifeline PCS COI Exp 1012017.pdf LPC Extension.docx LPC Facility Licenses Exp 1312017.pdf LPC Staff Licenses.pdf Contract Amendment 2 Contract Amendment 3~75.zip
Vendor Attachments: Attachment 01 ADCS Qualified Contractor Application Attachment 02 List of References Attachment 03 Licensure-Certification Attestation Attachment 04 Professional License Offer and Acceptance Sole Proprietor Waiver Independent Contractor Agreement Arizona Substitue W-9 Designation of Confidential Trade Secret and Proprietary Information HITECH Business Associate Agreement Counselor Licenses
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 000041334 - Lifeline PCS
Roxanne DalPos
335 N Alma School Rd
Suite E
Chandler, AZ 85224
US
Email: rdalpos@lifelinepcs.com
Phone: (480)641-1165
FAX: (480)641-9026
Alt. Reference: Z0001
Payment Terms: Net 30 Shipping Method: Best Way
Shipping Terms: N/A Freight Terms: Freight Allowed
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to rdalpos@lifelinepcs.com at 01/07/2016 10:27:07 AM 01/07/2016 10:49:57 AM
Change Order 1 Emailed to rdalpos@lifelinepcs.com at 09/01/2016 10:21:37 AM 09/01/2016 01:27:26 PM
Change Order 2 Emailed to rdalpos@lifelinepcs.com at 12/08/2016 01:53:11 PM
Change Order 3 Emailed to rdalpos@lifelinepcs.com at 12/08/2016 01:55:27 PM 12/08/2016 03:39:57 PM
Change Order 4 Emailed to rdalpos@lifelinepcs.com at 12/27/2017 01:06:04 PM 12/27/2017 04:46:10 PM
Change Order 5 Emailed to rdalpos@lifelinepcs.com at 10/11/2018 01:50:39 PM 10/12/2018 06:40:51 AM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
000041334
PZ000041334 Lifeline PCS 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
Item Information   
1-5 of 12
1 2  3 
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 #:  000035850-R1 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $80.00 HR - Hour 0.00 $0.00 $0.00 $80.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 2.0, Item # 2:   One (1) Hour Consultation - Rural 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 2 Quote # / Quote Item #:  000035850-R1 / 2
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $92.00 HR - Hour 0.00 $0.00 $0.00 $92.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 3.0, Item # 3:   One (1) Hour Unit Consultation - Urban 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 3 Quote # / Quote Item #:  000035850-R1 / 3
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $80.00 HR - Hour 0.00 $0.00 $0.00 $80.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 4.0, Item # 4:   One (1) Hour Unit Consultation - Rural 3PS - Sent
NIGP Code: 952-59
   Counseling/Consultation Program: HP04-00
Bid # / Bid Item #:  ADCS16-00005689 / 4 Quote # / Quote Item #:  000035850-R1 / 4
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $92.00 EA - Each 0.00 $0.00 $0.00 $92.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
Print Sequence # 5.0, Item # 5:   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 #:  000035850-R1 / 5
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $80.00 HR - Hour 0.00 $0.00 $0.00 $80.00
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
 
1-5 of 12
1 2  3 
Copyright © 2019 Periscope Holdings, Inc. - All Rights Reserved. AZ-PAS2